AMERIGROUP Community Care Validation of Performance Measures

3133 East Camelback Road, Suite 300 Phoenix, AZ 85016

Phone 602.264.6382 Fax 602.241.0757

Georgia Department of Community Health

Validation of Performance Measures

for

AMERIGROUP Community Care

Measurement Period: Calendar Year 2012 Validation Period: State Fiscal Year 2013

Publish Date: September 20, 2013

AMERIGROUP Community Care Validation of Performance Measures Page i State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

CONTENTS

for AMERIGROUP Community Care

Validation of Performance Measures ................................................................................................... 1 Validation Overview ............................................................................................................................. 1 Care Management Organization (CMO) Information ........................................................................... 1 Performance Measures Validated ....................................................................................................... 2 Description of Validation Activities ....................................................................................................... 4

Pre-Audit Strategy ............................................................................................................................. 4 Validation Team ................................................................................................................................ 4 Technical Methods of Data Collection and Analysis ......................................................................... 5 On-Site Activities ............................................................................................................................... 5

Data Integration, Data Control, and Performance Measure Documentation ....................................... 7 Data Integration ................................................................................................................................. 7 Data Control ...................................................................................................................................... 7 Performance Measure Documentation ............................................................................................. 7

Validation Results ................................................................................................................................ 8 Medical Service Data (Claims/Encounters) ....................................................................................... 8 Enrollment Data ................................................................................................................................ 8 Provider Data .................................................................................................................................... 9 Medical Record Review Process ...................................................................................................... 9 Supplemental Data ............................................................................................................................ 9 Data Integration ............................................................................................................................... 10 Performance Measure Specific Findings ........................................................................................ 10

Validation Findings ............................................................................................................................ 11 Appendix A. Data Integration and Control Findings ........................................................................ A-1

Appendix B. Denominator and Numerator Validation Findings ..................................................... B-1

Appendix C. Performance Measure Results ..................................................................................... C-1

Appendix D. Final Audited HEDIS Rates ........................................................................................... D-1

Appendix E. Performance Measure Validation Reporting Spreadsheet ........................................ E-1

Appendix F. HEDIS Interactive Data Submission System Data ...................................................... F-1

AMERIGROUP Community Care Validation of Performance Measures Page 1 State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Validation of Performance Measures for AMERIGROUP Community Care

Validation Overview

Validation of performance measures is one of three mandatory external quality review (EQR) activities that the Balanced Budget Act of 1997 (BBA) requires state Medicaid agencies to perform. Health Services Advisory Group, Inc. (HSAG), the external quality review organization (EQRO) for the Department of Community Health (DCH), conducted the validation activities. The DCH contracts with three care management organizations (CMOs) to provide services to Medicaid managed care enrollees and PeachCare for Kids® enrollees. PeachCare for Kids® is the name of Georgia’s stand-alone Children’s Health Insurance Program (CHIP). The DCH identified a set of performance measures that were calculated and reported by the CMOs for validation. HSAG conducted the validation activities as outlined in the Centers for Medicare & Medicaid Services (CMS) publication, EQR Protocol 2: Validation of Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR), Version 2.0, September 2012.

Care Management Organization (CMO) Information

HSAG validated performance measures calculated and reported by AMERIGROUP Community Care (AMERIGROUP). Information about AMERIGROUP appears in Table 1.

Table 1—AMERIGROUP Community Care Information

CMO Name: AMERIGROUP Community Care

CMO Location: 303 Perimeter Center North, Ste. 400 Atlanta, GA 30346

CMO Audit Location: 1300 Amerigroup Way Virginia Beach, VA 23464

CMO Contact: Tanya Chambers-Ashford, MPA, MSOC, Regulatory Market Manager

Contact Telephone Number: 678.587.4840, Ext. 74994

Contact E-mail Address: [email protected]

Site Visit Date: March 20–21, 2013

VALIDATION OF PERFORMANCE MEASURES


Performance Measures Validated

HSAG validated performance measures identified and selected by DCH for validation. All performance measures were selected from the Centers for Medicare & Medicaid Services’ (CMS) Initial Core Set of Children’s Health Care Quality Measures,1 the Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid,2 or the Agency for Healthcare Research and Quality (AHRQ). The measurement period was identified by DCH as calendar year (CY) 2012 for all measures except the two child core set dental measures. The dental measures were reported for federal fiscal year (FFY) 2012, which covered the time frame of October 1, 2011, through September 30, 2012, per CMS requirements. Table 2 lists the performance measures that HSAG validated and identifies who calculated the performance measure rates.

Table 2—List of CY 2012 Performance Measures for AMERIGROUP

Performance Measure Method Specifications Rate

Calculation by:

1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5–17)

Hybrid3 CMS Child Core Set

AMERIGROUP

2. Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 2–20)

Admin CMS Child Core Set AMERIGROUP

3. Cesarean Delivery Rate Admin AHRQ AMERIGROUP

4. Cesarean Rate for Nulliparous Singleton Vertex Admin CMS Child Core Set4

AMERIGROUP

5. Percentage of Eligibles that Received Dental Treatment Services

Admin CMS Child Core Set

AMERIGROUP

6. Percentage of Eligibles that Received Preventive Dental Services

Admin CMS Child Core Set

AMERIGROUP

7. Percentage of Live Births Weighing Less Than 2,500 Grams

Admin CMS Child Core Set/AHRQ

AMERIGROUP

8. Adult Asthma Admission Rate Admin CMS Adult Core Set

AMERIGROUP

9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Admin CMS Adult Core Set

AMERIGROUP

10. Congestive Heart Failure Admission Rate Admin CMS Adult Core Set

AMERIGROUP

11. Diabetes, Short-Term Complications Admission Rate

Admin CMS Adult Core Set

AMERIGROUP

1 The Centers for Medicare & Medicaid Services. Initial Core Set of Children’s Health Care Quality Measures, November 2012. 2 The Centers for Medicare & Medicaid Services. Initial Core Set of Health Care Quality Measures for Adults Enrolled in

Medicaid, February 2013. 3 Hybrid measures require both administrative data and medical record review. 4 The CMS measure specifications were modified by HSAG.



In addition to the AHRQ and the CMS adult and child core set measures audited by HSAG, DCH required AMERIGROUP to report a selected set of Healthcare Effectiveness Data and Information Set (HEDIS) measures to DCH. AMERIGROUP was required to contract with an NCQA-licensed audit organization and undergo an NCQA HEDIS Compliance AuditTM. Final audited HEDIS measure results from NCQA’s Interactive Data Submission System (IDSS) were submitted to HSAG and provided to DCH. Appendices D and E display the final audited HEDIS 2013 results for all required measures, covering the 2012 measurement period. HSAG will use these results in addition to the measures HSAG validated and displayed within this report as data sources for the annual EQR technical report.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). HEDIS Compliance AuditTM is a trademark of the National Committee for Quality Assurance (NCQA).



Description of Validation Activities

Pre-Audit Strategy

HSAG conducted the validation activities as outlined in the CMS performance measure validation protocol. To complete the validation activities for AMERIGROUP, HSAG obtained a list of the measures that were selected by DCH for validation.

HSAG then prepared a document request letter that was submitted to AMERIGROUP outlining the steps in the performance measure validation process. The document request letter included a request for source code for each performance measure; a completed HEDIS 2013 Record of Administration, Data Management, and Processes (Roadmap); and any additional supporting documentation necessary to complete the audit. HSAG responded to Roadmap-related questions received directly from AMERIGROUP during the pre-on-site phase.

For the on-site visit, HSAG prepared an agenda describing all visit activities and indicating the type of staffing needed for each session. HSAG provided the agenda to AMERIGROUP approximately one week prior to the on-site visit. HSAG also conducted a pre-on-site conference call with AMERIGROUP to discuss any outstanding Roadmap questions and on-site visit activity expectations.

Validation Team

The HSAG Performance Measure Validation Team was composed of a lead auditor and validation team members. HSAG assembled the team based on the skills required for the validation and requirements of AMERIGROUP. Some team members, including the lead auditor, participated in the on-site meetings at AMERIGROUP; others conducted their work at HSAG’s offices. Table 3 lists the validation team members, their positions, and their skills and expertise.

Table 3—Validation Team

Name and Role Skills and Expertise

John Couzins, MPH, CHCA Lead Auditor

Certified HEDIS auditor; performance measure knowledge, statistics, and analysis.

Judy Yip, PhD Source Code Review Manager and Audit Specialist, Audits

Auditing experience, HEDIS knowledge, performance measure knowledge, and source code review management.

Tammy GianFrancisco Project Leader, Audits

Performance measure validation coordination, communication, and scheduling.



Technical Methods of Data Collection and Analysis

The CMS performance measures validation protocol identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG conducted an analysis of these data:

NCQA’s HEDIS 2013 Roadmap: AMERIGROUP completed and submitted the required and relevant portions of its Roadmap for review by the validation team. The validation team used responses from the Roadmap to complete the pre-on-site assessment of the information systems.

Source code (programming language) for performance measures: AMERIGROUP contracted with Inovalon, an NCQA-Certified software vendor, to calculate rates for both HEDIS and non-HEDIS measures. The source code review was conducted via a Web-assisted session where Inovalon explained the process and source code to HSAG’s source code review team.

Supporting documentation: HSAG requested documentation that would provide reviewers with additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions. The validation team reviewed all supporting documentation, identifying issues or areas needing clarification for further follow-up.

On-Site Activities

HSAG conducted an on-site visit with AMERIGROUP on March 20 and 21, 2013. HSAG collected information using several methods, including interviews, system demonstration, review of data output files, primary source verification, observation of data processing, and review of data reports. The on-site visit activities are described as follows:

Opening meeting: The opening meeting included an introduction of the validation team and key AMERIGROUP staff members involved in the performance measure activities. The review purpose, the required documentation, basic meeting logistics, and queries to be performed were discussed.

Evaluation of system compliance: The evaluation included a review of the information systems, focusing on the processing of claims and encounter data, provider data, patient data, and inpatient data. Additionally, the review evaluated the processes used to collect and calculate the performance measure rates, including accurate numerator and denominator identification and algorithmic compliance (which evaluated whether rate calculations were performed correctly, all data were combined appropriately, and numerator events were counted accurately).

Review of Roadmap and supporting documentation: The review included processes used for collecting, storing, validating, and reporting performance measure rates. This session was designed to be interactive with key AMERIGROUP staff members so that the validation team could obtain a complete picture of all the steps taken to generate the performance measure rates. The goal of the session was to obtain a confidence level as to the degree of compliance with written documentation compared to the actual process. HSAG conducted interviews to confirm findings from the



documentation review, expand or clarify outstanding issues, and ascertain that written policies and procedures were used and followed in daily practice.

Overview of data integration and control procedures: The overview included discussion and observation of source code logic, a review of how all data sources were combined, and a review of how the analytic file was produced for the reporting of selected performance measure rates. HSAG performed primary source verification to further validate the output files and reviewed backup documentation on data integration. HSAG also addressed data control and security procedures during this session.

Closing conference: The closing conference included a summation of preliminary findings based on the review of the Roadmap and the on-site visit, and revisited the documentation requirements for any post-visit activities.

HSAG conducted several interviews with key AMERIGROUP staff members who were involved with performance measure reporting. Table 4 lists key AMERIGROUP interviewees:

Table 4—List of AMERIGROUP Community Care Interviewees

Name Title

Pauline Tukey Business Analyst, Clinical Quality Management

Stacy M. Williams Manager, Clinical Quality Management

Jiong Huang Vice President, Quality Management

Tawonna Ingram Director, HEDIS/Health Promotions

Joanne Soublis Director, Plan Compliance

Michelle Rush Associate Vice President, Provider Relations

Monica Lester Director, Contracting

William Alexander Chief Medical Officer

Angela Evans Manager, Performance Reporting

Gail Brown Manager, Performance Reporting

Bing Zhu Business Analyst



Data Integration, Data Control, and Performance Measure Documentation

There are several aspects crucial to the calculation of performance measure rates. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report.

Data Integration

Accurate data integration is essential for calculating valid performance measure rates. The steps used to combine various data sources (including claims/encounter data, eligibility data, and other administrative data) must be carefully controlled and validated. HSAG validated the data integration process used by AMERIGROUP, which included a review of file consolidations or extracts, a comparison of source data to warehouse files, data integration documentation, source code, production activity logs, and linking mechanisms. Overall, the validation team determined that the data integration processes in place at AMERIGROUP were:

Acceptable

Not acceptable

Data Control

AMERIGROUP’s organizational infrastructure must support all necessary information systems; and its quality assurance practices and backup procedures must be sound to ensure timely and accurate processing of data, and to provide data protection in the event of a disaster. HSAG validated the data control processes AMERIGROUP used which included a review of disaster recovery procedures, data backup protocols, and related policies and procedures. Overall, the validation team determined that the data control processes in place at AMERIGROUP were:

Acceptable

Not acceptable

Performance Measure Documentation

Sufficient, complete documentation is necessary to support validation activities. While interviews and system demonstrations provided supplementary information, the majority of the validation review findings were based on documentation provided by AMERIGROUP. HSAG reviewed all related documentation, which included the completed Roadmap, job logs, computer programming code, output files, work flow diagrams, narrative descriptions of performance measure calculations, and other related documentation. Overall, the validation team determined that the documentation of performance measure calculations by AMERIGROUP was:

Acceptable

Not acceptable



Validation Results

The validation team evaluated AMERIGROUP’s data systems for processing of each type of data used for reporting DCH performance measure rates. General findings are indicated below:

Medical Service Data (Claims/Encounters)

AMERIGROUP used Facets for processing medical claims. Both paper and electronic claims were received daily. Paper claims were received by the Document Management Group, scanned, and sent to a vendor for data entry. Two data entry vendors were used during the measurement year, and all files were transmitted back to AMERIGROUP in a standard electronic HIPAA 837 format. The low volume of paper claims (5 percent) helped to minimize errors.

Electronic claims accounted for approximately 95 percent of all claims and were received from three data clearinghouses (Emdeon, Capario, and Availity) or via the provider Web portal, where providers could directly enter the claims for processing by AMERIGROUP. Prior to processing, all claims were loaded into a central repository, where they received automated system edit checks, and then, if passed, were loaded into Facets on a nightly basis where they underwent the adjudication process. The auto-adjudication rate during the measurement year was approximately 75 percent, and pended claims were worked daily by examiners to ensure no backlogs occurred. Appropriate controls, reconciliation processes, and tracking mechanisms were in place to monitor accurate and complete transmission for both paper and electronic claims. AMERIGROUP’s Quality Assurance staff conducted random, statistically valid, monthly audits with a sample of 204 claims to evaluate the financial, payment, and statistical accuracy of claims processing. No significant deficiencies were detected during the measurement year.

Vendor data included pharmacy and dental claims. Pharmacy claims were received from Caremark during 2012. These data were received and processed according to established timelines between AMERIGROUP and Caremark. Dental claims were received from Scion Dental. Claim volumes and receipt dates were also monitored closely to ensure claims were processed and audited. As in prior years, the vendor team had good oversight of all data received and worked closely with the vendors to ensure data were received timely and completely. There were no concerns with the vendor data processing.

Enrollment Data

AMERIGROUP’s enrollment data processing was the same as the previous year. Monthly enrollment files and daily files, which included demographic changes, terminations, additions, and voids, were received from DCH’s enrollment broker. These files were downloaded daily by the information systems department and submitted through a compliance checker and EDINET. The Membership Enrollment and Editing Tool (MEET) was used to identify and correct errors. The State’s fiscal agent also provided an end-of-month adjustment file that included voided transactions (e.g., the member was not or never was eligible). AMERIGROUP performed a monthly reconciliation of their enrollment data with the State’s data. To further ensure accuracy,



AMERIGROUP compared the total number of records downloaded with the number loaded into an MS Access database, as well as the claims processing system, Facets. There were no issues receiving enrollment data from the State during 2012, and there were no backlogs in processing the files. The auditor had no concerns with AMERIGROUP’s enrollment data.

Provider Data

AMERIGROUP was compliant with provider data processing. The providers’ specialties were used in two of the 11 audited measures. AMERIGROUP used two systems for housing the provider data: Cactus for credentialing and Facets for billing and payment. Initial credentialing applications were received by AMERIGROUP. All provider information was loaded into Cactus (AMERIGROUP’s current credentialing data system). Standard primary source verification was conducted by AMERIGROUP on all credentialing information. As credentialing decisions were rendered, notification was sent to the Provider Management Department and the information was also used to update Facets. Auditing of the credentialing process was performed monthly using a sample-based methodology. Through an automated feed, practitioner data were loaded into Facets, which eliminated the possibility of manual data entry errors into Facets. Provider validation of claims occurred at the time of receipt prior to entry within the adjudication system. AMERIGROUP implemented different levels (daily, weekly, and monthly) of edit checks on practitioner data submitted via claims. AMERIGROUP used a common practitioner ID to identify unique practitioners. For providers that could not be identified on a claim submission, the claim was pended to a manual work flow process. To further ensure accuracy and completeness, AMERIGROUP’s audit team manually reviewed 25 percent of all completed practitioner records on a monthly basis. Overall, there were no concerns with the practitioner data used for performance measure reporting.

Medical Record Review Process

AMERIGROUP was fully compliant with the medical record review reporting requirements. AMERIGROUP’s health plan review staff procured and collected the medical record documentation into the Quality Spectrum Hybrid Reporter (QSHR) hybrid tool. HSAG reviewed the QSHR hybrid tool and corresponding instructions. Reviewer qualifications, training, and oversight were appropriate. Due to reporting a new State-required hybrid measure, a convenience sample was required and subsequently passed. AMERIGROUP passed the medical record review validation process for the Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5–17) measure.

Supplemental Data

AMERIGROUP did not use any supplemental data that contributed to the production of the selected performance measures.



Data Integration

AMERIGROUP had a thorough and detailed process in place to ensure no data were lost during the data integration process. AMERIGROUP contracted with Inovalon, an NCQA-Certified software vendor, for calculating the 2013 performance measure rates. A uniform format was created for each data type to avoid data integration issues during the compilation process. All data were provided to Inovalon, and there were communications with Inovalon to ensure that all data elements needed for deriving the rates for the measures were provided. Throughout the process of data integration, internal benchmarks were created, and ongoing rate review was conducted by AMERIGROUP to ensure data integrity and accuracy. For security and backup, data from Facets were stored in the CMO’s corporate data warehouse. AMERIGROUP appropriately backed up its data, and no data were lost during the measurement year.

Primary source verification by HSAG was also performed for all performance measures, and no issues were identified through this review. HSAG also reviewed and approved Inovalon’s programming code for these measures.

Performance Measure Specific Findings

Based on all validation activities, the HSAG Performance Measure Validation Team determined validation results for each performance measure rate. Table 5 displays the key review results. For detailed information, see Appendix B of this report.

Table 5—Key Review Results for AMERIGROUP Community Care

Performance Measures Key Review Findings

1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5–17) No concerns were identified.


No concerns were identified.

3. Cesarean Delivery Rate No concerns were identified.

4. Cesarean Rate for Nulliparous Singleton Vertex No concerns were identified.

5. Percentage of Eligibles that Received Dental Treatment Services No concerns were identified.

6. Percentage of Eligibles that Received Preventive Dental Services No concerns were identified.

7. Percentage of Live Births Weighing Less Than 2,500 Grams No concerns were identified.

8. Adult Asthma Admission Rate No concerns were identified.

9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate No concerns were identified.

10. Congestive Heart Failure Admission Rate No concerns were identified.

11. Diabetes, Short-Term Complications Admission Rate No concerns were identified.



Validation Findings

HSAG provided an audit designation for each performance measure as defined in Table 6:

Table 6—Validation Findings Definitions

Report (R) The organization followed the specifications and produced a reportable rate or result for the measure.

Not Reportable (NR)

The calculated rate was materially biased, or the organization chose not to report the measure, or the organization was not required to report the measure.

According to the CMS protocol, the validation finding for each measure is determined by the magnitude of the errors detected for the audit elements, not by the number of audit elements determined to be “Not Reportable.” Consequently, it is possible that an error for a single audit element may result in a designation of “NR” because the impact of the error biased the reported performance measure rate by more than 5 percentage points. Conversely, it is also possible that several audit element errors may have little impact on the reported rate, resulting in a measure designation of “R.”

Table 7 shows the final validation findings for AMERIGROUP for each performance measure rate. For additional information regarding performance measure rates, see Appendix C of this report.

Table 7—Key Review Results for AMERIGROUP Community Care

Performance Measures Validation Finding

1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5–17) R


R

3. Cesarean Delivery Rate R

4. Cesarean Rate for Nulliparous Singleton Vertex R

5. Percentage of Eligibles that Received Dental Treatment Services R

6. Percentage of Eligibles that Received Preventive Dental Services R

7. Percentage of Live Births Weighing Less Than 2,500 Grams R

8. Adult Asthma Admission Rate R

9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate R

10. Congestive Heart Failure Admission Rate R

11. Diabetes, Short-Term Complications Admission Rate R

AMERIGROUP Community Care Validation of Performance Measures Page A-1 State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix A. Data Integration and Control Findingsfor AMERIGROUP Community Care

Documentation Worksheet

CMO Name: AMERIGROUP Community Care

On-Site Visit Date: March 20–21, 2013

Reviewers: John Couzins, MPH, CHCA

Table A-1—Data Integration and Control Findings for AMERIGROUP Community Care

Data Integration and Control Element Met Not Met N/A Comments

Accuracy of data transfers to assigned performance measure data repository.

The CMO accurately and completely processes transfer data from the transaction files (e.g., membership, provider, encounter/claims) into the performance measure data repository used to keep the data until the calculations of the performance measures have been completed and validated.

Samples of data from the performance measure data repository are complete and accurate.

Accuracy of file consolidations, extracts, and derivations.

The CMO’s processes to consolidate diversified files and to extract required information from the performance measure data repository are appropriate.

Actual results of file consolidations or extracts are consistent with those that should have resulted according to documented algorithms or specifications.

Procedures for coordinating the activities of multiple subcontractors ensure the accurate, timely, and complete integration of data into the performance measure database.

Computer program reports or documentation reflect vendor coordination activities, and no data necessary to performance measure reporting are lost or inappropriately modified during transfer.

If the CMO uses a performance measure data repository, its structure and format facilitates any required programming necessary to calculate and report required performance measures.

The performance measure data repository’s design, program flow charts, and source codes enable analyses and reports.

Proper linkage mechanisms are employed to join data from all necessary sources (e.g., identifying a member with a given disease/condition).

DATA INTEGRATION AND CONTROL FINDINGS

AMERIGROUP Community Care Validation of Performance Measures Page A-2 State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Table A-1—Data Integration and Control Findings for AMERIGROUP Community Care

Data Integration and Control Element Met Not Met N/A Comments

Assurance of effective management of report production and of the reporting software.

Documentation governing the production process, including CMO production activity logs and the CMO staff review of report runs, is adequate.

Prescribed data cutoff dates are followed.

The CMO retains copies of files or databases used for performance measure reporting in case results need to be reproduced.

The reporting software program is properly documented with respect to every aspect of the performance measure data repository, including building, maintaining, managing, testing, and report production.

The CMO’s processes and documentation comply with the CMO standards associated with reporting program specifications, code review, and testing.

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Appendix B. Denominator and Numerator Validation Findings for AMERIGROUP Community Care

Reviewer Worksheets

CMO Name: AMERIGROUP Community Care On-Site Visit Date: March 20–21, 2013 Reviewers: John Couzins, MPH, CHCA

Table B-1—Denominator Validation Findings for AMERIGROUP Community Care

Audit Element Met Not Met N/A Comments

For each of the performance measures, all members of the relevant populations identified in the performance measure specifications are included in the population from which the denominator is produced.

Adequate programming logic or source code exists to appropriately identify all relevant members of the specified denominator population for each of the performance measures.

The CMO correctly calculates member months and member years if applicable to the performance measure.

The CMO properly evaluates the completeness and accuracy of any codes used to identify medical events, such as diagnoses, procedures, or prescriptions, and these codes are appropriately identified and applied as specified in each performance measure.

If any time parameters are required by the specifications of the performance measure, they are followed (e.g., cutoff dates for data collection, counting 30 calendar days after discharge from a hospital).

Exclusion criteria included in the performance measure specifications are followed.

Systems or methods used by the CMO to estimate populations when they cannot be accurately or completely counted (e.g., newborns) are valid.

Population estimates were not necessary.

DENOMINATOR AND NUMERATOR VALIDATION FINDINGS

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Table B-2—Numerator Validation Findings for AMERIGROUP Community Care

Audit Element Met Not Met N/A Comments

The CMO uses the appropriate data, including linked data from separate data sets, to identify the entire at-risk population.

Qualifying medical events (such as diagnoses, procedures, prescriptions, etc.) are properly identified and confirmed for inclusion in terms of time and services.

The CMO avoids or eliminates all double-counted members or numerator events.

Any nonstandard codes used in determining the numerator are mapped to a standard coding scheme in a manner that is consistent, complete, and reproducible, as evidenced by a review of the programming logic or a demonstration of the program.

Nonstandard codes were not used or reported.

If any time parameters are required by the specifications of the performance measure, they are followed (i.e., the measured event occurred during the time period specified or defined in the performance measure).

AMERIGROUP Community Care Validation of Performance Measures Page C-1 State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix C. Performance Measure Results for AMERIGROUP Community Care

Performance Measure 1—Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5–17)

Table C-1—Performance Measure 1 for AMERIGROUP Community Care

Rate

Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5–17) 84.02%

Performance Measure 2—Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 2–20)


Rate

Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 2–20)

12.88%

Performance Measure 3—Cesarean Delivery Rate


Rate

Cesarean Delivery Rate 29.76%

Performance Measure 4—Cesarean Rate for Nulliparous Singleton Vertex


Rate

Cesarean Rate for Nulliparous Singleton Vertex 18.14%

PERFORMANCE MEASURE RESULTS


Performance Measure 5—Percentage of Eligibles that Received Dental Treatment Services


Rate

Percentage of Eligibles that Received Dental Treatment Services 24.11%

Performance Measure 6—Percentage of Eligibles that Received Preventive Dental Services


Rate

Percentage of Eligibles that Received Preventive Dental Services 50.75%

Performance Measure 7—Percentage of Live Births Weighing Less Than 2,500 Grams


Rate

Percentage of Live Births Weighing Less Than 2,500 Grams 8.45%

Performance Measure 8—Adult Asthma Admission Rate


Rate

(Per 100,000)

Adult Asthma Admission Rate 61.74

PERFORMANCE MEASURE RESULTS


Performance Measure 9—Chronic Obstructive Pulmonary Disease (COPD) Admission Rate


Rate

(Per 100,000)

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate 76.56

Performance Measure 10—Congestive Heart Failure Admission Rate


Rate

(Per 100,000)

Congestive Heart Failure Admission Rate 29.64

Performance Measure 11—Diabetes, Short-Term Complications Admission Rate


Rate

(Per 100,000)

Diabetes, Short-Term Complications Admission Rate 27.62

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Appendix D. Final Audited HEDIS Ratesfor AMERIGROUP Community Care

Table D-1—CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for AMERIGROUP Community Care

Measure CMO Rate

Adolescent Well-Care Visits 46.58%

Adults’ Access to Preventive/Ambulatory Health Services— Ages 20–44 Years

83.84%

Adults’ Access to Preventive/Ambulatory Health Services— Ages 45–64 Years

90.25%

Adults’ Access to Preventive/Ambulatory Health Services— Ages 65+ Years

Denominator fewer than 30

Adults’ Access to Preventive/Ambulatory Health Services—Total 84.79%

Adult BMI Assessment 62.70%

Annual Dental Visit—Ages 2–3 Years 48.50%






Annual Dental Visit—Total 69.92%

Annual Monitoring for Patients on Persistent Medications— ACE Inhibitors or ARBs

90.93%

Annual Monitoring for Patients on Persistent Medications—Anticonvulsants

61.43%

Annual Monitoring for Patients on Persistent Medications—Digoxin Denominator fewer than 30

Annual Monitoring for Patients on Persistent Medications—Diuretics 89.80%

Annual Monitoring for Patients on Persistent Medications—Total 89.32%

Antibiotic Utilization—Percent of Antibiotics of Concern of All Antibiotic Scrips—Total

41.48%

Antidepressant Medication Management—Effective Acute Phase Treatment

54.16%

Antidepressant Medication Management—Effective Continuation Phase Treatment

36.81%

Appropriate Testing for Children with Pharyngitis 77.44%

FINAL AUDITED HEDIS RATES



Measure CMO Rate

Appropriate Treatment for Children with Upper Respiratory Infection (URI)*

82.66%

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis* 17.83%

Breast Cancer Screening 59.22%

Call Answer Timeliness 85.71%

Cervical Cancer Screening 72.09%

Cholesterol Management for Patients with Cardiovascular Conditions—LDL-C Screening

87.50%

Cholesterol Management for Patients with Cardiovascular Conditions—LDL-C Control

27.50%

Childhood Immunization Status—Combo 3 82.64%



Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12–24 Months

97.55%

Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 25 Months–6 Years

91.44%

Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 7–11 Years

92.26%

Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12–19 Years

90.08%

Chlamydia Screening in Women 56.98%

Comprehensive Diabetes Care—Blood Pressure Control <140/80 32.61%

Comprehensive Diabetes Care—Blood Pressure Control <140/90 55.07%

Comprehensive Diabetes Care—Eye Exam 48.25%

Comprehensive Diabetes Care—HbA1c Control <7.0 30.56%

Comprehensive Diabetes Care—HbA1c Control <8.0 38.94%

Comprehensive Diabetes Care—HbA1c Poor Control >9.0 ** 53.58%

Comprehensive Diabetes Care—HbA1c Testing 79.37%

Comprehensive Diabetes Care—LDL-C Screening 73.21%

Comprehensive Diabetes Care—LDL-C Control 27.29%

Comprehensive Diabetes Care—Medical Attention to Nephropathy 74.38%




Measure CMO Rate

Controlling High Blood Pressure 38.72%

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis

65.00%

Follow-Up After Hospitalization for Mental Illness—30 Day Follow-Up 67.29%

Follow-Up After Hospitalization for Mental Illness—7 Day Follow-Up 45.80%

Follow-Up Care for Children Prescribed ADHD Medication—Initiation Phase

42.32%

Follow-Up Care for Children Prescribed ADHD Medication—Continuation and Maintenance Phase

58.15%

Frequency of Ongoing Prenatal Care—< 21 Percent 10.65%

Frequency of Ongoing Prenatal Care—21–40 Percent 4.17%



Frequency of Ongoing Prenatal Care—81+ Percent 66.44%

Human Papillomavirus Vaccine for Female Adolescents 16.71%

Immunizations for Adolescents—Combo 1 71.43%

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment—Initiation of Treatment

41.87%

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment—Engagement of Treatment

10.01%

Inpatient Utilization—General Hospital/Acute Care—Total Rates reported in Appendix E

Lead Screening in Children 74.06%

Asthma Medication Ratio—Total: 5–64 Years 62.40%

Medication Management for People with Asthma— Total-Medication Compliance 50%

43.64%

Medication Management for People with Asthma— Total-Medication Compliance 75%

20.07%

Persistence of Beta-Blocker Treatment After a Heart Attack Denominator fewer than 30

Pharmacotherapy Management of COPD Exacerbation— Systemic Corticosteroid

63.27%

Pharmacotherapy Management of COPD Exacerbation—Bronchodilator 83.67%

Prenatal and Postpartum Care—Postpartum Care 59.49%

Prenatal and Postpartum Care—Timeliness of Prenatal Care 84.72%




Measure CMO Rate

Use of Appropriate Medications for People with Asthma— Ages 5–11 Years

90.32%


88.69%


69.17%


Denominator fewer than 30

Use of Appropriate Medications for People with Asthma—Total 89.03%

Use of Imaging Studies for Low Back Pain* 74.22%

Use of Spirometry Testing in the Assessment and Diagnosis of COPD 23.26%

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents—Total BMI

40.74%

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents—Total Nutrition

52.31%

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents—Total Physical Activity

39.81%

Well-Child Visits in the First 15 Months of Life—Zero Visits 1.49%

Well-Child Visits in the First 15 Months of Life—One Visit 1.74%

Well-Child Visits in the First 15 Months of Life—Two Visits 3.97%

Well-Child Visits in the First 15 Months of Life—Three Visits 3.47%

Well-Child Visits in the First 15 Months of Life—Four Visits 7.94%

Well-Child Visits in the First 15 Months of Life—Five Visits 18.36%

Well-Child Visits in the First 15 Months of Life—Six or More Visits 63.03%

Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life 68.21%

Ambulatory Care Rates reported in Appendix F

Board Certification Rates reported in Appendix F

Enrollment by Product Line—Total Rates reported in Appendix F

Enrollment by State Rates reported in Appendix F

Frequency of Selected Procedures Rates reported in Appendix F

Identification of Alcohol and Other Drug Services—Total Rates reported in Appendix F

Language Diversity of Membership Rates reported in Appendix F

Mental Health Utilization Rates reported in Appendix F




Measure CMO Rate

Race/Ethnicity Diversity of Membership Rates reported in Appendix F

Total Membership Rates reported in Appendix F

Weeks of Pregnancy at Time of Enrollment Rates reported in Appendix F

* The measure is reported as an inverted rate. A higher rate indicates appropriate treatment of children with URI, for example (i.e., the proportion for whom antibiotics were not prescribed). The rate is calculated as 1 minus the numerator divided by the eligible population.

** Lower rate is better.

AMERIGROUP Community Care Validation of Performance Measures Page E-1 State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix E. Performance Measure Validation Reporting Spreadsheet for AMERIGROUP Community Care

Appendix E contains AMERIGROUP Community Care’s performance measure validation reporting spreadsheet.

Appendix E: Department of Community Health, State of GeorgiaValidated CY 2012 Performance Measures for AMERIGROUP

CMO Name: Amerigroup Community Care

CMO Contact Name and Title: Tawonna Ingram - Director Health Promotions/HEDIS

CMO Contact Email: [email protected]

Comments:

2013 Validation of Performance Measures Rate Reporting Template

1 of 12 September 2013


Data Element General Measure Data

Reporting Year 2013

Data collection methodology (administrative) A

Eligible population 12661

Numerator events by administrative data 3768

Reported rate 29.76

Cesarean Delivery Rate




Reporting Year 2013

Data collection methodology (administrative)

A



Reported rate 50.75%

Percentage of Eligibles that Received Preventive Dental Services




Reporting Year 2013





Percentage of Eligibles that Received Dental Treatment Services



Data ElementGeneral Measure

Data

Reporting Year 2013





Cesarean Rate for Nulliparous Singleton Vertex




Reporting Year 2013


A



Reported rate 8.45

Percentage of Live Births Weighing Less Than 2,500 Grams




Reporting Year 2013


A




Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 2-20)




Reporting Year 2013

Data collection methodology (hybrid) H


Denominator 338


Numerator events by medical records 8

Numerator Total 284


Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5-17)




Data

Reporting Year 2013




Reported rate (Per 100,000 Members) 28

Diabetes, Short-Term Complications Admission Rate




Data

Reporting Year 2013


A




Chronic Obstructive Pulmonary Disease (COPD) Admission Rate




Data

Reporting Year 2013


A




Congestive Heart Failure (CHF) Admission Rate



Data ElementGeneral

Measure Data

Reporting Year 2013





Adult Asthma Admission Rate


AMERIGROUP Community Care Validation of Performance Measures Page F-1 State of Georgia AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix F. HEDIS Interactive Data Submission System Data for AMERIGROUP Community Care

Appendix F contains AMERIGROUP Community Care’s reported IDSS data.

Appendix F: Department of Community Health, State of GeorgiaAudited CY 2012 HEDIS Measure Results for AMERIGROUP

Measure/Data ElementReport

MeasureBenefit Offered

Rotated Measure

Rate Reportable Comment

Adult BMI Assessment (aba) Y N 62.70% R Reportable

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (wcc)

Y N

BMI Percentile 40.74% R Reportable

Counseling for Nutrition 52.31% R Reportable

Counseling for Physical Activity 39.81% R Reportable

Childhood Immunization Status (cis) Y N

DTaP 88.66% R Reportable

IPV 96.30% R Reportable

MMR 94.21% R Reportable

HiB 95.83% R Reportable

Hepatitis B 93.98% R Reportable

VZV 95.60% R Reportable

Pneumococcal Conjugate 88.43% R Reportable

Hepatitis A 93.98% R Reportable

Rotavirus 71.53% R Reportable

Influenza 45.37% R Reportable

Combination #2 85.42% R Reportable









Immunizations for Adolescents (ima) Y

Meningococcal 73.51% R Reportable

Audit Review TableAmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Effectiveness of Care: Prevention and Screening



Tdap/Td 84.68% R Reportable


Human Papillomavirus Vaccine for Female Adolescents (hpv)

Y 16.71% R Reportable

Lead Screening in Children (lsc) Y N 74.06% R Reportable

Breast Cancer Screening (bcs) Y 59.22% R Reportable

Cervical Cancer Screening (ccs) Y 72.09% R Reportable

Chlamydia Screening in Women (chl) Y

16-20 Years 53.93% R Reportable


Total 56.98% R Reportable

Appropriate Testing for Children with Pharyngitis (cwp)

Y Y 77.44% R Reportable

Appropriate Treatment for Children With URI (uri) Y Y 82.66% R Reportable

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab)


Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)


Pharmacotherapy Management of COPD Exacerbation (pce)

Y Y

Systemic Corticosteroid 63.27% R Reportable

Bronchodilator 83.67% R Reportable

Use of Appropriate Medications for People With Asthma (asm)

Y Y




51-64 Years NA R Denominator fewer than 30


Medication Management for People With Asthma (mma)

Y Y

5-11 Years - Medication Compliance 50% 44.00% R Reportable

Effectiveness of Care: Respiratory Conditions








51-64 Years - Medication Compliance 50% NA R Denominator fewer than 30


Total - Medication Compliance 50% 43.64% R Reportable


Asthma Medication Ratio (amr) Y Y






Cholesterol Management for Patients With Cardiovascular Conditions (cmc)

Y Y

LDL-C Screening Performed 87.50% R Reportable

LDL-C Control (<100 mg/dL) 27.50% R Reportable

Controlling High Blood Pressure (cbp) Y 38.72% R ReportablePersistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Y Y NA R Denominator fewer than 30

Comprehensive Diabetes Care (cdc) Y N

Hemoglobin A1c (HbA1c) Testing 79.37% R Reportable

HbA1c Poor Control (>9.0%) 53.58% R Reportable

HbA1c Control (<8.0%) 38.94% R Reportable


Eye Exam (Retinal) Performed 48.25% R Reportable



Medical Attention for Nephropathy 74.38% R Reportable

Blood Pressure Control (<140/80 mm Hg) 32.61% R Reportable


Effectiveness of Care: Cardiovascular

Effectiveness of Care: Diabetes

Effectiveness of Care: Musculoskeletal



Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art)


Use of Imaging Studies for Low Back Pain (lbp) Y 74.22% R Reportable

Antidepressant Medication Management (amm) Y Y

Effective Acute Phase Treatment 54.16% R Reportable

Effective Continuation Phase Treatment 36.81% R Reportable

Follow-Up Care for Children Prescribed ADHD Medication (add)

Y Y

Initiation Phase 42.32% R Reportable

Continuation and Maintenance (C&M) Phase 58.15% R Reportable

Follow-Up After Hospitalization for Mental Illness (fuh)

Y Y

30-Day Follow-Up 67.29% R Reportable


Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd)


Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)

Y NA R Denominator fewer than 30

Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc)


Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)


Annual Monitoring for Patients on Persistent Medications (mpm)

Y Y

ACE Inhibitors or ARBs 90.93% R Reportable

Digoxin NA R Denominator fewer than 30

Diuretics 89.80% R Reportable

Anticonvulsants 61.43% R Reportable


Adults' Access to Preventive/Ambulatory Health Services (aap)

Y

Effectiveness of Care: Behavioral Health

Effectiveness of Care: Medication Management

Access/Availability of Care





65+ Years NA R Denominator fewer than 30

Total 84.79% R ReportableChildren and Adolescents' Access to Primary Care Practitioners (cap)

Y

12-24 Months 97.55% R Reportable

25 Months - 6 Years 91.44% R Reportable



Annual Dental Visit (adv) Y Y








Initiation and Engagement of AOD Dependence Treatment (iet)

Y Y

Initiation of AOD Treatment: 13-17 Years 39.37% R Reportable

Engagement of AOD Treatment: 13-17 Years 15.24% R Reportable

Initiation of AOD Treatment: 18+ Years 42.60% R Reportable

Engagement of AOD Treatment: 18+ Years 8.50% R Reportable

Initiation of AOD Treatment: Total 41.87% R Reportable

Engagement of AOD Treatment: Total 10.01% R Reportable

Prenatal and Postpartum Care (ppc) Y

Timeliness of Prenatal Care 84.72% R Reportable

Postpartum Care 59.49% R Reportable

Call Answer Timeliness (cat) Y 85.71% R Reportable

Frequency of Ongoing Prenatal Care (fpc) Y

<21 Percent 10.65% R Reportable

21-40 Percent 4.17% R Reportable



Utilization



81+ Percent 66.44% R Reportable

Well-Child Visits in the First 15 Months of Life (w15)

Y N

0 Visits 1.49% R Reportable

1 Visit 1.74% R Reportable





6+ Visits 63.03% R ReportableWell-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)

Y N 68.21% R Reportable

Adolescent Well-Care Visits (awc) Y N 46.58% R Reportable

Frequency of Selected Procedures (fsp) Y R Reportable

Ambulatory Care: Total (amba) Y R Reportable

Ambulatory Care: Dual Eligibles (ambb) N NR Measure Unselected

Ambulatory Care: Disabled (ambc) N NR Measure Unselected

Ambulatory Care: Other (ambd) N NR Measure Unselected

Inpatient Utilization--General Hospital/Acute Care: Total (ipua)

Y R Reportable

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)

N NR Measure Unselected

Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)


Inpatient Utilization--General Hospital/Acute Care: Other (ipud)


Identification of Alcohol and Other Drug Services: Total (iada)

Y Y R Reportable

Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)

N N NR Measure Unselected

Identification of Alcohol and Other Drug Services: Disabled (iadc)


Identification of Alcohol and Other Drug Services: Other (iadd)


Mental Health Utilization: Total (mpta) Y Y R Reportable

Mental Health Utilization: Dual Eligibles (mptb) N N NR Measure Unselected



Mental Health Utilization: Disabled (mptc) N N NR Measure Unselected

Mental Health Utilization: Other (mptd) N N NR Measure Unselected

Antibiotic Utilization: Total (abxa) Y Y R Reportable

Antibiotic Utilization: Dual Eligibles (abxb) N N NR Measure Unselected

Antibiotic Utilization: Disabled (abxc) N N NR Measure Unselected

Antibiotic Utilization: Other (abxd) N N NR Measure Unselected

Relative Resource Use for People With Diabetes (rdi)

Y R Reportable

Relative Resource Use for People With Asthma (ras)

Y Y R Reportable

Relative Resource Use for People With Cardiovascular Conditions (rca)

Y R Reportable

Relative Resource Use for People With Hypertension (rhy)

Y R Reportable

Relative Resource Use for People With COPD (rco) Y R Reportable

Board Certification (bcr) Y R Reportable

Total Membership (tlm) Y R Reportable

Enrollment by Product Line: Total (enpa) Y R Reportable

Enrollment by Product Line: Dual Eligibles (enpb) N NR Measure Unselected

Enrollment by Product Line: Disabled (enpc) N NR Measure Unselected

Enrollment by Product Line: Other (enpd) N NR Measure Unselected

Enrollment by State (ebs) Y R Reportable

Race/Ethnicity Diversity of Membership (rdm) Y R Reportable

Language Diversity of Membership (ldm) Y R Reportable

Weeks of Pregnancy at Time of Enrollment in MCO (wop)

Y R Reportable

Relative Resource Use

Health Plan Descriptive Information



Data ElementMeasure

Data

Measurement year 2012

Data collection methodology (administrative or hybrid) H


Number of numerator events by administrative data in eligible population (before exclusions) 311

Current year's administrative rate (before exclusions) 5.33%

Minimum required sample size (MRSS) or other sample size 411

Oversampling rate 0.05

Final sample size (FSS) 432

Number of numerator events by administrative data in FSS 30

Administrative rate on FSS 6.94%

Number of original sample records excluded because of valid data errors 0

Number of administrative data records excluded 1

Number of medical records excluded 2

Number of employee/dependent medical records excluded 0

Records added from the oversample list 0

Denominator 429




Lower 95% confidence interval 58.01%

Upper 95% confidence interval 67.40%

Adult BMI Assessment (ABA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



3-11 years 12-17 years Total 3-11 years 12-17 years Total 3-11 years 12-17 years Total

Measurement year

Data collection methodology (administrative or hybrid)

Eligible population 65481 32453 97,934 65481 32453 97,934 65481 32453 97,934

Number of numerator events by administrative data in eligible population (before exclusions)

3580 1778 5,358 2243 1315 3,558 1769 998 2,767

Current year's administrative rate (before exclusions)

5.47% 5.48% 5.47% 3.43% 4.05% 3.63% 2.70% 3.08% 2.83%

Minimum required sample size (MRSS) or other sample size

Oversampling rate

Final sample size

Number of numerator events by administrative data in FSS

16 13 29 7 6 13 6 4 10

Administrative rate on FSS 3.70% 3.01% 6.71% 1.62% 1.39% 3.01% 1.39% 0.93% 2.31%

Number of original sample records excluded because of valid data errors

Number of administrative data records excluded

Number of medical records excluded

Number of employee/dependent medical records excluded

Records added from the oversample list

Denominator 294 138 432 294 138 432 294 138 432

Numerator events by administrative data 16 13 29 7 6 13 6 4 10

Numerator events by medical records 95 52 147 155 58 213 108 54 162

Reported rate 37.76% 47.10% 40.74% 55.10% 46.38% 52.31% 38.78% 42.03% 39.81%

Lower 95% confidence interval 32.04% 38.41% 35.99% 49.25% 37.69% 47.49% 33.04% 33.43% 35.08%

Upper 95% confidence interval 43.47% 55.79% 45.49% 60.96% 55.06% 57.14% 44.52% 50.63% 44.55%

0 0 0

0 0 0

0 0 0

0 0 0

432 432 432

0 0 0

411 411 411

0.05 0.05 0.05

2012 2012 2012

H H H

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Data ElementBMI Percentile Counseling for Nutrition Counseling for Physical Activity




DataDTaP IPV MMR HiB Hepatitis B VZV

Pneumo- coccal

Conjugate



Eligible population 6961Number of numerator events by admin data in eligible

population (before exclusions)5149 5859 6418 6440 5845 6474 5569

Current year's administrative rate (before exclusions) 73.97% 84.17% 92.20% 92.52% 83.97% 93.00% 80.00%

Minimum required sample size (MRSS) or other sample Size 411


Final sample size 432

Number of numerator events by admin data in FSS 346 379 402 407 367 406 360

Administrative rate on FSS 80.09% 87.73% 93.06% 94.21% 84.95% 93.98% 83.33%Number of original records excluded because of valid data

errors0


Number of medical data records excluded 0



Denominator 432

Numerator events by administrative data 346 379 402 407 367 406 360

Number of numerator events by medical records 37 37 5 7 39 7 22

Reported rate 88.66% 96.30% 94.21% 95.83% 93.98% 95.60% 88.43%

Lower 95% confidence interval 85.55% 94.40% 91.90% 93.83% 91.62% 93.55% 85.29%

Upper 95% confidence interval 91.76% 98.19% 96.53% 97.83% 96.34% 97.65% 91.56%

Childhood Immunization Status (CIS)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Hepatitis A Rotavirus InfluenzaCombination

2Combination

3Combination

4Combination

5Combination

6Combination

7Combination

8Combination

9Combination

10

6354 3633 2953 4476 4240 4182 2615 2100 2587 2084 1376 1369

91.28% 52.19% 42.42% 64.30% 60.91% 60.08% 37.57% 30.17% 37.16% 29.94% 19.77% 19.67%

402 241 191 299 286 283 175 144 173 144 91 91

93.06% 55.79% 44.21% 69.21% 66.20% 65.51% 40.51% 33.33% 40.05% 33.33% 21.06% 21.06%

402 241 191 299 286 283 175 144 173 144 91 91

4 68 5 70 71 71 99 33 99 33 47 47

93.98% 71.53% 45.37% 85.42% 82.64% 81.94% 63.43% 40.97% 62.96% 40.97% 31.94% 31.94%

91.62% 67.16% 40.56% 81.97% 78.95% 78.20% 58.77% 36.22% 58.29% 36.22% 27.43% 27.43%

96.34% 75.90% 50.18% 88.86% 86.33% 85.69% 68.08% 45.73% 67.63% 45.73% 36.46% 36.46%




DataMeningococcal Tdap/Td Combination 1




Number of numerator events by admin data in eligible population (before exclusions) 5475 6230 5356

Current year's administrative rate (before exclusions) 72.63% 82.65% 71.05%

Minimum required sample size (MRSS) or other sample Size 366


Final sample size 385

Number of numerator events by admin data in FSS 274 316 267

Administrative rate on FSS 71.17% 82.08% 69.35%

Number of original records excluded because of valid data errors 0





Denominator 385

Numerator events by administrative data 274 316 267

Number of numerator events by medical records 9 10 8

Reported rate 73.51% 84.68% 71.43%

Lower 95% confidence interval 68.97% 80.95% 66.79%

Upper 95% confidence interval 78.04% 88.40% 76.07%

Immunizations for Adolescents (IMA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

DataMeasurement year 2012















Denominator 431






Human Papillomavirus Vaccine for Female Adolescents (HPV)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data Elements which do not apply to the selected data collection methodology will not appear General Measure

Data




Number of numerator events by admin data in eligible population (before exclusions) 5168












Denominator 320






Lead Screening in Children (LSC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Lead Screening in Children




Data








Breast Cancer Screening (BCS)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data
















Denominator 430






Cervical Cancer Screening (CCS)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)




Data16-20 years 21-24 years Total



Eligible population 4387 1127 5,514

Numerator events by administrative data 2366 776 3,142

Reported rate 53.93% 68.86% 56.98%

Lower 95% confidence interval 52.45% 66.11% 55.67%

Upper 95% confidence interval 55.42% 71.60% 58.30%

Chlamydia Screening in Women (CHL)

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data








Appropriate Testing for Children with Pharyngitis (CWP)




Data ElementMeasure

Data








Appropriate Treatment for Children With URI (URI)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data




Total numerator events by administrative data 461




Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data








Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data Elements Measure

DataSystemic

corticosteroidBronchodilator




Numerator events by administrative data 31 41

Reported rate 63.27% 83.67%

Lower 95% confidence interval 48.75% 72.30%

Upper 95% confidence interval 77.78% 95.04%

Pharmacotherapy Management of COPD Exacerbation (PCE)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacotherapy Management of COPD Exacerbation




Data5-11 years 12-18 years 19-50 years 51-64 years Total



Eligible population 2169 1308 120 12 3,609

Number of required exclusions 240 139 117 18 514

Numerator events by administrative data 1959 1160 83 11 3,213

Reported rate 90.32% 88.69% 69.17% NA 89.03%

Lower 95% confidence interval 89.05% 86.93% 60.49% NA 87.99%

Upper 95% confidence interval 91.59% 90.44% 77.85% NA 90.06%

Use of Appropriate Medications for People With Asthma (ASM)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)




Data

Medication Compliance

50%


75%


50%


75%


50%


75%


50%


75%



A

Eligible population

Number of required exclusionsNumerator events by administrative

data862 404 493 220 37 13 10 8

Reported rate 44.00% 20.62% 42.50% 18.97% 44.58% 15.66% NA NA

Lower 95% confidence interval 41.78% 18.81% 39.61% 16.67% 33.28% 7.24% NA NA

Upper 95% confidence interval 46.23% 22.44% 45.39% 21.26% 55.87% 24.08% NA NA

1959 1160 83 11

450 287 154 19

Medication Management for People With Asthma (MMA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

5-11 years 12-18 years 19-50 years 51-64 years




50%


75%

1,402 645

43.64% 20.07%

41.90% 18.67%

45.37% 21.48%

3,213

910

Total



Data ElementMeasure

Data5-11 years 12-18 years 19-50 years 51-64 years Total




Number of required exclusions 243 143 118 18 522


Reported rate 62.42% 64.26% 40.34% NA 62.40%

Lower 95% confidence interval 60.36% 61.62% 31.10% NA 60.80%

Upper 95% confidence interval 64.48% 66.90% 49.57% NA 64.00%

Asthma Medication Ratio (AMR)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)




Data

LDL-C Screening

LDL-C level <100 mg/dL




Number of numerator events by administrative data in eligible population (before exclusions) 33 7

Current year's administrative rate (before exclusions) 82.50% 17.50%




Number of numerator events by administrative data in FSS 33 6

Administrative rate on FSS 82.50% 15.00%




Denominator 40


Numerator events by medical records 2 5




Cholesterol Management for Patients With Cardiovascular Conditions (CMC)





Data


Data collection methodology (hybrid) H










Number of records excluded because of false positive diagnoses 0





Denominator 452






Controlling High Blood Pressure (CBP)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data





Reported rate NA

Lower 95% confidence interval NA

Upper 95% confidence interval NA

Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementHbA1c Testing

HbA1c Poor Control (>9.0%)

HbA1c Control (<8.0%)

HbA1c Control

(<7.0%) for a Selected

Population

Eye ExamLDL-C

ScreeningLDL-C Level <100 mg/dL

Medical Attention for Nephropathy

Measurement year 2012 2012 2012 2012 2012 2012 2012 2012

Data collection methodology (administrative or hybrid) H H H H H H H H

Eligible population 1103 1103 1103 953 1103 1103 1103 1103

Number of numerator events by administrative data in eligible population (before optional exclusions)

829 886 186 140 416 736 152 741

Current year's administrative rate (before optional exclusions)

75.16% 80.33% 16.86% 14.69% 37.72% 66.73% 13.78% 67.18%

Minimum required sample size (MRSS) or other sample size

548 548 548 548 548 548 548 548

Oversampling rate 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1

Final sample size (FSS) 603 603 603 603 603 603 603 603Number of numerator events by administrative data in

FSS469 512 76 56 270 429 69 418

Administrative rate on FSS 77.78% 84.91% 12.60% 9.29% 44.78% 71.14% 11.44% 69.32%Number of original sample records excluded because

of valid data errors2 2 2 2 2 2 2 2

Number of optional administrative data records excluded

0 0 0 0 0 0 0 0

Number of optional medical data records excluded 0 0 0 0 0 0 0 0Number of HbA1c <7 required medical records

excluded7

Number of HbA1c <7 required administrative data records excluded

90

Number of employee/dependent medical records excluded

0 0 0 0 0 0 0 0

Records added from the oversample list 0 0 0 0 0 0 0 0

Denominator 601 601 601 504 601 601 601 601

Numerator events by administrative data 469 261 76 56 270 429 69 418

Comprehensive Diabetes Care (CDC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Numerator events by medical records 8 61 158 98 20 11 95 29

Reported rate 79.37% 53.58% 38.94% 30.56% 48.25% 73.21% 27.29% 74.38%

Lower 95% confidence interval 76.05% 49.51% 34.95% 26.43% 44.17% 69.59% 23.64% 70.80%

Upper 95% confidence interval 82.69% 57.65% 42.92% 34.68% 52.33% 76.84% 30.93% 77.95%



Blood Pressure

Controlled <140/80 mm

Hg

Blood Pressure

Controlled <140/90 mm

Hg

2012 2012

H H

1103 1103

14 20

1.27% 1.81%

548 548

0.1 0.1

603 603

6 9

1.00% 1.49%

2 2

0 0

0 0

0 0

0 0

601 601

6 9



190 322

32.61% 55.07%

28.78% 51.01%

36.44% 59.13%



Data ElementMeasure

Data








Disease Modifying Anti-Rheumatic Drug therapy in Rheumatoid Arthritis (ART)




Data ElementMeasure

Data






Lower 95% confidence Interval 71.12%

Upper 95% confidence Interval 77.31%

Use of Imaging Studies for Low Back Pain (LBP)





Data

Effective Acute Phase

Treatment

Effective Continuation

Phase Treatment








Antidepressant Medication Management (AMM)





Data

Initiation Phase

Continuation and

Maintenance Phase



Eligible population 2455 411





Follow-Up Care for Children Prescribed ADHD Medication (ADD)





Data

30-day follow-up

7-day follow-up








Follow-Up After Hospitalization for Mental Illness (FUH)




Data ElementMeasure

Data




Number of required exclusions 173





Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are




Data ElementMeasure

Data




Number of optional exclusions 0


Reported rate NA



Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data





Reported rate NA



Cardiovascular Monitoring for People With Cardiovascular Disease and




Data ElementMeasure

Data




Number of required exclusions 23





Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)





Data

ACE Inhibitors or

ARBsDigoxin Diuretics

Anti- convulsants

Total





Reported rate 90.93% NA 89.80% 61.43% 89.32%

Lower 95% confidence interval 89.00% NA 87.80% 49.31% 87.91%

Upper 95% confidence interval 92.86% NA 91.79% 73.55% 90.74%

Annual Monitoring for Patients on Persistent Medications (MPM)





Data20-44 years 45-64 years 65+ years Total



Eligible population 10744 1857 2 12,603

Numerator events by administrative data 9008 1676 2 10,686

Reported rate 83.84% 90.25% NA 84.79%

Lower 95% confidence interval 83.14% 88.88% NA 84.16%

Upper 95% confidence interval 84.54% 91.63% NA 85.42%

Adults' Access to Preventive/Ambulatory Health Services (AAP)





Data

12-24 months

25 months - 6 years

7-11 years 12-19 years



Eligible population 9228 43488 29437 34602

Numerator events by administrative data 9002 39767 27158 31168

Reported rate 97.55% 91.44% 92.26% 90.08%

Lower 95% confidence interval 97.23% 91.18% 91.95% 89.76%

Upper 95% confidence interval 97.87% 91.71% 92.57% 90.39%

Children and Adolescents' Access to Primary Care Practitioners (CAP)




Data ElementMeasure

Data2-3 Years 4-6 Years 7-10 Years 11-14 Years 15-18 Years 19-21 Years



Eligible population 17078 27101 33388 31813 23897 1182

Numerator events by administrative data 8282 20986 26590 23028 14709 422

Reported rate 48.50% 77.44% 79.64% 72.39% 61.55% 35.70%

Lower 95% confidence interval 47.74% 76.94% 79.21% 71.89% 60.93% 32.93%

Upper 95% confidence interval 49.25% 77.94% 80.07% 72.88% 62.17% 38.48%

Annual Dental Visit (ADV)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Total

134,459

94,017

69.92%

69.68%

70.17%



Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment



Eligible population

Numerator events by administrative data 124 48 466 93 590

Reported rate 39.37% 15.24% 42.60% 8.50% 41.87%

Lower 95% confidence interval 33.81% 11.11% 39.62% 6.80% 39.26%

Upper 95% confidence interval 44.92% 19.37% 45.57% 10.20% 44.49%

315 1094 1,

Initiation and Engagement of AOD Dependence Treatment (IET)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Data ElementsGeneral Measure

Data

13-17 years 18+ years T



Engagement of AOD Treatment

141

10.01%

8.40%

11.61%

,409

otal



Data ElementTimeliness of Prenatal

Care

Postpartum Care

Measurement year 2012 2012

Data collection methodology (administrative or hybrid) H H

Eligible population 12505 12505Number of numerator events by administrative data in eligible population (before

exclusions)5963 4838

Current year's administrative rate (before exclusions) 47.68% 38.69%

Minimum required sample size (MRSS) or other sample size 411 411

Oversampling rate 0.05 0.05

Final sample size (FSS) 432 432

Number of numerator events by administrative data in FSS 205 178

Administrative rate on FSS 47.45% 41.20%

Number of original sample records excluded because of valid data errors 0 0

Number of employee/dependent medical records excluded 0 0

Records added from the oversample list 0 0

Denominator 432 432


Numerator events by medical records 161 79




Prenatal and Postpartum Care (PPC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Data ElementMeasure

Data








Call Answer Timeliness (CAT)





Data<21 Percent

21-40 Percent

41-60 Percent

61-80 Percent

81+ Percent



Eligible population 12505Number of numerator events by administrative data in eligible population

(before exclusions)6312 1985 1070 864 2274

Current year's administrative rate (before exclusions) 50.48% 15.87% 8.56% 6.91% 18.18%




Number of numerator events by administrative data in FSS 44 14 15 10 88

Administrative rate on FSS 10.19% 3.24% 3.47% 2.31% 20.37%




Denominator 432

Numerator events by administrative data 44 14 15 10 88

Numerator events by medical records 2 4 18 38 199

Reported rate 10.65% 4.17% 7.64% 11.11% 66.44%

Lower 95% confidence interval 7.62% 2.17% 5.02% 8.03% 61.87%

Upper 95% confidence interval 13.67% 6.17% 10.26% 14.19% 71.00%

Frequency of Ongoing Prenatal Care (FPC)




Data ElementMeasure

Data0 visits 1 visit 2 visits 3 visits 4 visits 5 visits



Eligible population 7568Number of numerator events by administrative data in eligible

population (before exclusions)136 206 304 466 835 1431

Current year's administrative rate (before exclusions) 1.80% 2.72% 4.02% 6.16% 11.03% 18.91%




Number of numerator events by administrative data in FSS 8 8 24 14 47 84

Administrative rate on FSS 1.98% 1.98% 5.94% 3.47% 11.63% 20.79%Number of original sample records excluded because of valid data

errors1



Denominator 403

Numerator events by administrative data 6 7 15 9 32 59

Numerator events by medical records 0 0 1 5 0 15

Reported rate 1.49% 1.74% 3.97% 3.47% 7.94% 18.36%

Lower 95% confidence interval 0.18% 0.34% 1.94% 1.56% 5.18% 14.46%

Upper 95% confidence interval 2.80% 3.14% 6.00% 5.39% 10.70% 22.27%

Well-Child Visits in the First 15 Months of Life (W15)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



6 or more visits

4190

55.36%

219

54.21%

222

32

63.03%

58.19%

67.86%



Data ElementMeasure

Data














Denominator 453






Adolescent Well-Care Visits (AWC)




Data ElementMeasure

Data














Denominator 453






Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)




Age Male Female Total

0-9 853,450 829,770 1,683,237

10-19 557,165 568,126 1,125,291

15-44 546,711

20-44 33,102 320,952

30-64 30,610

45-64 8,454 29,891

Procedure Age SexNumber of Procedures

Procedures / 1,000 Member

Years

Male 0 0.00

Female 1 0.00

Male 0 0.00

Female 45 0.14

Male 0 0.00

Female 6 0.20

0-9 1246 0.74

10-19 390 0.35

15-44 107 0.20

45-64 28 0.94

15-44 142 0.26

45-64 18 0.60

30-64 Male 1 0.03

15-44 9 0.02

45-64 3 0.10

30-64 Male 7 0.23

15-44 449 0.82

45-64 18 0.60

Male 29 0.88

Female 52 0.16

Cholecystectomy, OpenFemale

Cholecystectomy (laparoscopic)Female

Back Surgery

20-44

TonsillectomyMale & Female

Hysterectomy, Abdominal Female

Hysterectomy, Vaginal Female

Frequency of Selected Procedures (FSP)


Bariatric weight loss surgery

0-19

20-44

45-64



Male 9 1.06

Female 12 0.40

15-44 43 0.08

45-64 63 2.11

15-44 109 0.20

45-64 57 1.91

Mastectomy Female

Lumpectomy Female

Back Surgery

45-64



AgeMember Months

<1 240,609

1-9 1,442,628

10-19 1,125,291

20-44 354,054

45-64 38,345

65-74 67

75-84 3

85+ 2

Unknown 0

Total 3,200,999

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

<1 188944 785.27 23676 98.40

1-9 490093 339.72 74929 51.94

10-19 270469 240.35 44399 39.46

20-44 159632 450.87 45385 128.19

45-64 28779 750.53 3366 87.78

65-74 44 656.72 4 59.70

75-84 7 2,333.33 0 0.00

85+ 2 1,000.00 1 500.00

Unknown 0 0

Total 1,137,970 355.50 191,760 59.91

Ambulatory Care: Total (AMBA)


Age

Outpatient Visits ED Visits



AgeMember Months

<1 NR

1-9 NR

10-19 NR

20-44 NR

45-64 NR

65-74 NR

75-84 NR

85+ NR

Unknown NR

Total NR

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

<1 NR NR NR NR

1-9 NR NR NR NR

10-19 NR NR NR NR

20-44 NR NR NR NR

45-64 NR NR NR NR

65-74 NR NR NR NR

75-84 NR NR NR NR

85+ NR NR NR NR

Unknown NR NR

Total NR NR NR NR

Ambulatory Care: Dual Eligibles (AMBB)


Age




AgeMember Months

<1 NR

1-9 NR

10-19 NR

20-44 NR

45-64 NR

65-74 NR

75-84 NR

85+ NR

Unknown NR

Total NR

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

<1 NR NR NR NR

1-9 NR NR NR NR

10-19 NR NR NR NR

20-44 NR NR NR NR

45-64 NR NR NR NR

65-74 NR NR NR NR

75-84 NR NR NR NR

85+ NR NR NR NR

Unknown NR NR

Total NR NR NR NR

Ambulatory Care: Disabled (AMBC)


Age




AgeMember Months

<1 NR

1-9 NR

10-19 NR

20-44 NR

45-64 NR

65-74 NR

75-84 NR

85+ NR

Unknown NR

Total NR

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

<1 NR NR NR NR

1-9 NR NR NR NR

10-19 NR NR NR NR

20-44 NR NR NR NR

45-64 NR NR NR NR

65-74 NR NR NR NR

75-84 NR NR NR NR

85+ NR NR NR NR

Unknown NR NR

Total NR NR NR NR

Ambulatory Care: Other (AMBD)


Age




AgeMember Months

<1 240,609

1-9 1,442,628

10-19 1,125,291

20-44 354,054

45-64 38,345

65-74 67

75-84 3

85+ 2

Unknown 0

Total 3,200,999

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 1391 5.78 10170 42.27 7.31

1-9 1201 0.83 4032 2.79 3.36

10-19 2981 2.65 9218 8.19 3.09

20-44 13608 38.43 40009 113.00 2.94

45-64 456 11.89 2259 58.91 4.95

65-74 3 44.78 17 253.73 5.67

75-84 0 0.00 0 0.00 NA

85+ 0 0.00 0 0.00 NA

Unknown 0 0 NA

Total 19,640 6.14 65,705 20.53 3.35

Inpatient Utilization--General Hospital/Acute Care: Total (IPUA)


Total Inpatient

Medicine



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 1046 4.35 4662 19.38 4.46

1-9 856 0.59 2327 1.61 2.72

10-19 454 0.40 1438 1.28 3.17

20-44 627 1.77 2268 6.41 3.62

45-64 240 6.26 913 23.81 3.80

65-74 2 29.85 10 149.25 5.00

75-84 0 0.00 0 0.00 NA

85+ 0 0.00 0 0.00 NA

Unknown 0 0 NA

Total 3,225 1.01 11,618 3.63 3.60

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 345 1.43 5508 22.89 15.97

1-9 345 0.24 1705 1.18 4.94

10-19 373 0.33 1882 1.67 5.05

20-44 551 1.56 3151 8.90 5.72

45-64 203 5.29 1314 34.27 6.47

65-74 1 14.93 7 104.48 7.00

75-84 0 0.00 0 0.00 NA

85+ 0 0.00 0 0.00 NA

Unknown 0 0 NA

Total 1,818 0.57 13,567 4.24 7.46

Surgery

Maternity*



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

10-19 2154 1.91 5898 5.24 2.74

20-44 12430 35.11 34590 97.70 2.78

45-64 13 0.34 32 0.83 2.46

Unknown 0 0 NA

Total 14,597 9.62 40,520 26.70 2.78 *The maternity category is calculated using member months for members 10-64 years.



AgeMember Months

<1 NR

1-9 NR

10-19 NR

20-44 NR

45-64 NR

65-74 NR

75-84 NR

85+ NR

Unknown NR

Total NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR

10-19 NR NR NR NR NR





85+ NR NR NR NR NR

Unknown NR NR NR

Total NR NR NR NR NR

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (IPUB)


Total Inpatient

Medicine



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Surgery

Maternity*



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Unknown NR NR NR

Total NR NR NR NR NR *The maternity category is calculated using member months for members 10-64 years.



AgeMember Months

<1 NR

1-9 NR

10-19 NR

20-44 NR

45-64 NR

65-74 NR

75-84 NR

85+ NR

Unknown NR

Total NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Inpatient Utilization--General Hospital/Acute Care: Disabled (IPUC)


Total Inpatient

Medicine



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Surgery

Maternity*



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Unknown NR NR NR




AgeMember Months

<1 NR

1-9 NR

10-19 NR

20-44 NR

45-64 NR

65-74 NR

75-84 NR

85+ NR

Unknown NR

Total NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Inpatient Utilization--General Hospital/Acute Care: Other (IPUD)


Total Inpatient

Medicine



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 NR NR NR NR NR

1-9 NR NR NR NR NR






85+ NR NR NR NR NR

Unknown NR NR NR


Surgery

Maternity*



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Unknown NR NR NR




Male Female Total Male Female Total Male Female Total Male Female

0-12 1073843 1045524 2,119,367 1073843 1045524 2,119,367 1073843 1045524 2,119,367 1073843 1045524

13-17 294975 292587 587,562 294975 292587 587,562 294975 292587 587,562 294975 292587

18-24 46430 144969 191,399 46430 144969 191,399 46430 144969 191,399 46430 144969

25-34 14463 159399 173,862 14463 159399 173,862 14463 159399 173,862 14463 159399

35-64 22460 106260 128,720 22460 106260 128,720 22460 106260 128,720 22460 106260

65+ 19 53 72 19 53 72 19 53 72 19 53

Unknown 0 0 0 0 0 0 0 0 0 0 0

Total 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792

Number Percent Number Percent Number Percent Number Percent

M 47 0.05% 9 0.01% 1 0.00% 40 0.04%

F 23 0.03% 5 0.01% 0 0.00% 21 0.02%

Total 70 0.04% 14 0.01% 1 0.00% 61 0.03%

M 371 1.51% 57 0.23% 13 0.05% 332 1.35%

F 213 0.87% 57 0.23% 5 0.02% 175 0.72%

Total 584 1.19% 114 0.23% 18 0.04% 507 1.04%

M 87 2.25% 17 0.44% 1 0.03% 82 2.12%

F 375 3.10% 134 1.11% 9 0.07% 287 2.38%

Total 462 2.90% 151 0.95% 10 0.06% 369 2.31%

M 105 8.71% 18 1.49% 1 0.08% 95 7.88%

F 813 6.12% 266 2.00% 33 0.25% 668 5.03%

Total 918 6.34% 284 1.96% 34 0.23% 763 5.27%

M 167 8.92% 51 2.72% 7 0.37% 146 7.80%

F 608 6.87% 163 1.84% 19 0.21% 532 6.01%

Total 775 7.22% 214 2.00% 26 0.24% 678 6.32%

M 0 0.00% 0 0.00% 0 0.00% 0 0.00%

F 0 0.00% 0 0.00% 0 0.00% 0 0.00%

Total 0 0.00% 0 0.00% 0 0.00% 0 0.00%

0-12

13-17

18-24

25-34

35-64

65+

Age SexAny Services Inpatient

Intensive Outpatient/Partial

HospitalizationOutpatient/ED

Identification of Alcohol and Other Drug Services: Total (IADA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

AgeMember Months (Any) Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Member Months (Outpa



M 0 NA 0 NA 0 NA 0 NA

F 0 NA 0 NA 0 NA 0 NA

Total 0 NA 0 NA 0 NA 0 NA

M 777 0.64% 152 0.13% 23 0.02% 695 0.57%

F 2,032 1.39% 625 0.43% 66 0.05% 1,683 1.15%

Total 2,809 1.05% 777 0.29% 89 0.03% 2,378 0.89%

Unknown

Total



Total2,119,367

587,562

191,399

173,862

128,720

72

0

3,200,982

atient/ED)






0-12 NR NR NR NR NR NR NR NR NR NR NR





65+ NR NR NR NR NR NR NR NR NR NR NR

Unknown NR NR NR NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR NR NR NR


M NR NR NR NR NR NR NR NR

F NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR
















0-12

13-17

18-24

25-34

35-64

65+




Identification of Alcohol and Other Drug Services: Dual Eligibles (IADB)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)












Unknown

Total



TotalNR

NR

NR

NR

NR

NR

NR

NR

atient/ED)





Male Female Total Male Female Total Male Female Total Male Female0-12 NR NR NR NR NR NR NR NR NR NR NR



























0-12

13-17

18-24

25-34

35-64

65+




Identification of Alcohol and Other Drug Services: Disabled (IADC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)












Unknown

Total



TotalNR

NR

NR

NR

NR

NR

NR

NR

atient/ED)

































0-12

13-17

18-24

25-34

35-64

65+




Identification of Alcohol and Other Drug Services: Other (IADD)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)












Unknown

Total



TotalNR

NR

NR

NR

NR

NR

NR

NR

atient/ED)






0-12 1073843 1045524 2,119,367 1073843 1045524 2,119,367 1073843 1045524 2,119,367 1073843 1045524

13-17 294975 292587 587,562 294975 292587 587,562 294975 292587 587,562 294975 292587

18-64 83353 410628 493,981 83353 410628 493,981 83353 410628 493,981 83353 410628

65+ 19 53 72 19 53 72 19 53 72 19 53

Unknown 0 0 0 0 0 0 0 0 0 0 0

Total 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792


M 7119 7.96% 149 0.17% 45 0.05% 7100 7.93%

F 4350 4.99% 88 0.10% 40 0.05% 4329 4.97%

Total 11,469 6.49% 237 0.13% 85 0.05% 11,429 6.47%

M 3200 13.02% 236 0.96% 69 0.28% 3166 12.88%

F 3011 12.35% 357 1.46% 80 0.33% 2940 12.06%

Total 6,211 12.68% 593 1.21% 149 0.30% 6,106 12.47%

M 574 8.26% 72 1.04% 16 0.23% 543 7.82%

F 3669 10.72% 386 1.13% 66 0.19% 3528 10.31%

Total 4,243 10.31% 458 1.11% 82 0.20% 4,071 9.89%

M 0 0.00% 0 0.00% 0 0.00% 0 0.00%

F 1 22.64% 0 0.00% 0 0.00% 1 22.64%

Total 1 16.67% 0 0.00% 0 0.00% 1 16.67%

M 0 NA 0 NA 0 NA 0 NA

F 0 NA 0 NA 0 NA 0 NA

Total 0 NA 0 NA 0 NA 0 NA

M 10,893 9.00% 457 0.38% 130 0.11% 10,809 8.93%

F 11,031 7.57% 831 0.57% 186 0.13% 10,798 7.41%

Total 21,924 8.22% 1,288 0.48% 316 0.12% 21,607 8.10%

0-12

13-17

18-64

65+

Unknown

Total




Mental Health Utilization: Total (MPTA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)






Total2,119,367

587,562

493,981

72

0

3,200,982

atient/ED)





























0-12

13-17

18-64

65+

Unknown

Total




Mental Health Utilization: Dual Eligibles (MPTB)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)






TotalNR

NR

NR

NR

NR

NR

atient/ED)





























0-12

13-17

18-64

65+

Unknown

Total




Mental Health Utilization: Disabled (MPTC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)






TotalNR

NR

NR

NR

NR

NR

atient/ED)





























0-12

13-17

18-64

65+

Unknown

Total




Mental Health Utilization: Other (MPTD)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)






TotalNR

NR

NR

NR

NR

NR

atient/ED)



Age Male Female Total

0-9 853450 829770 1,683,220

10-17 515368 508341 1,023,709

18-34 60893 304368 365,261

35-49 18730 91492 110,222

50-64 3730 14768 18,498

65-74 16 51 67

75-84 3 0 3

85+ 0 2 2

Unknown 0 0 0

Total 1,452,190 1,748,792 3,200,982

Age SexTotal

Antibiotic Scrips

Average Scrips

PMPY for Antibiotics

Total Days Supplied for All Antibiotic

Scrips

Average Days

Supplied per Antibiotic

Scrip

Total Number of Scrips for Antibiotics of Concern

Average Scrips PMPY for

Anitbiotics of Concern

Percentage of Antibiotics of Concern of all

Antibiotic Scrips

M 95434 1.34 899895 9.43 42398 0.60 44.43%

F 92536 1.34 879049 9.50 38881 0.56 42.02%

Total 187,970 1.34 1,778,944 9.46 81,279 0.58 43.24%

M 28302 0.66 290865 10.28 12574 0.29 44.43%

F 36468 0.86 353640 9.70 15006 0.35 41.15%

Total 64,770 0.76 644,505 9.95 27,580 0.32 42.58%

M 3896 0.77 40342 10.35 1478 0.29 37.94%

F 48761 1.92 385005 7.90 16066 0.63 32.95%

Total 52,657 1.73 425,347 8.08 17,544 0.58 33.32%

M 1914 1.23 17014 8.89 814 0.52 42.53%

F 15487 2.03 131552 8.49 6470 0.85 41.78%

Total 17,401 1.89 148,566 8.54 7,284 0.79 41.86%

M 397 1.28 3524 8.88 193 0.62 48.61%

F 2260 1.84 19134 8.47 1117 0.91 49.42%

18-34

35-49

50-64

Antibiotic Utilization: Total (ABXA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacy Benefit Member Months

Antibiotic Utilization

0-9

10-17



Total 2,657 1.72 22,658 8.53 1,310 0.85 49.30%

M 1 0.75 10 10.00 0 0.00 0.00%

F 9 2.12 76 8.44 2 0.47 22.22%

Total 10 1.79 86 8.60 2 0.36 20.00%

M 1 4.00 7 7.00 0 0.00 0.00%

F 0 NA 0 NA 0 NA NA

Total 1 4.00 7 7.00 0 0.00 0.00%

M 0 NA 0 NA 0 NA NA

F 0 0.00 0 NA 0 0.00 NA

Total 0 0.00 0 NA 0 0.00 NA

M 0 NA 0 NA 0 NA NA

F 0 NA 0 NA 0 NA NA

Total 0 NA 0 NA 0 NA NA

M 129,945 1.07 1,251,657 9.63 57,457 0.47 44.22%

F 195,521 1.34 1,768,456 9.04 77,542 0.53 39.66%

Total 325,466 1.22 3,020,113 9.28 134,999 0.51 41.48%

Age SexTotal

Quinolone Scrips

Average Scrips

PMPY for Quinolones

Total Cephalo-

sporin 2nd-4th

Generation Scrips

Average Scrips

PMPY for Cephalo-

sporins 2nd-4th

Generation

Total Azithromyci

n and Clarithro-

mycin Scrips


Azithromycins and Clarithro-

mycins

Total Amoxicillin/ Clavulanate

Scrips


Amoxicillin/ Clavulanates

Total Ketolides

Scrips

M 50 0.00 9297 0.13 17101 0.24 14840 0.21 0

F 54 0.00 8834 0.13 15622 0.23 13266 0.19 0

Total 104 0.00 18,131 0.13 32,723 0.23 28,106 0.20 0

M 223 0.01 1590 0.04 6507 0.15 3447 0.08 0

F 650 0.02 1914 0.05 7878 0.19 3588 0.08 0

Total 873 0.01 3,504 0.04 14,385 0.17 7,035 0.08 0

M 212 0.04 85 0.02 689 0.14 297 0.06 0

F 3619 0.14 920 0.04 7370 0.29 2339 0.09 0

Total 3,831 0.13 1,005 0.03 8,059 0.26 2,636 0.09 0

M 205 0.13 41 0.03 321 0.21 135 0.09 0

F 1894 0.25 337 0.04 2646 0.35 951 0.12 0

Total 2,099 0.23 378 0.04 2,967 0.32 1,086 0.12 0

35-49

Unknown

Total

Antibiotics of Concern Utilization

0-9

10-17

18-34

65-74

75-84

85+



M 55 0.18 13 0.04 80 0.26 28 0.09 0

F 417 0.34 54 0.04 412 0.33 151 0.12 0

Total 472 0.31 67 0.04 492 0.32 179 0.12 0

M 0 0.00 0 0.00 0 0.00 0 0.00 0

F 1 0.24 0 0.00 0 0.00 1 0.24 0

Total 1 0.18 0 0.00 0 0.00 1 0.18 0

M 0 0.00 0 0.00 0 0.00 0 0.00 0

F 0 NA 0 NA 0 NA 0 NA 0

Total 0 0.00 0 0.00 0 0.00 0 0.00 0

M 0 NA 0 NA 0 NA 0 NA 0

F 0 0.00 0 0.00 0 0.00 0 0.00 0

Total 0 0.00 0 0.00 0 0.00 0 0.00 0

M 0 NA 0 NA 0 NA 0 NA 0

F 0 NA 0 NA 0 NA 0 NA 0

Total 0 NA 0 NA 0 NA 0 NA 0

M 745 0.01 11,026 0.09 24,698 0.20 18,747 0.15 0

F 6,635 0.05 12,059 0.08 33,928 0.23 20,296 0.14 0

Total 7,380 0.03 23,085 0.09 58,626 0.22 39,043 0.15 0

Age Sex

Total Absorbable Sulfonamide

Scrips

Average Scrips

PMPY for Absorbable Sulfonamide

s

Total Amino- glycoside

Scrips

Average Scrips

PMPY for Amino-

glycosides

Total 1st Generation Cephalo-

sporin Scrips

Average Scrips PMPY for 1st Generation Cephalo- sporins

Total Lincosamide

Scrips


Lincosamides

Total Macrolides

(not azith. or clarith.) Scrips

M 3848 0.05 5 0.00 5850 0.08 0 0.00 104

F 6036 0.09 1 0.00 6150 0.09 0 0.00 91

Total 9,884 0.07 6 0.00 12,000 0.09 0 0.00 195

M 1936 0.05 5 0.00 2910 0.07 0 0.00 93

F 3456 0.08 0 0.00 3063 0.07 0 0.00 109

Total 5,392 0.06 5 0.00 5,973 0.07 0 0.00 202

M 397 0.08 0 0.00 337 0.07 0 0.00 27

F 4103 0.16 0 0.00 3275 0.13 0 0.00 248

Total 4,500 0.15 0 0.00 3,612 0.12 0 0.00 275

M 207 0.13 1 0.00 181 0.12 0 0.00 16

F 1559 0.20 0 0.00 967 0.13 0 0.00 90

Total

All Other Antibiotics Utilization

0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown



Total 1,766 0.19 1 0.00 1,148 0.12 0 0.00 106

M 29 0.09 0 0.00 29 0.09 0 0.00 1

F 227 0.18 0 0.00 219 0.18 0 0.00 17

Total 256 0.17 0 0.00 248 0.16 0 0.00 18

M 1 0.75 0 0.00 0 0.00 0 0.00 0

F 4 0.94 0 0.00 0 0.00 0 0.00 0

Total 5 0.90 0 0.00 0 0.00 0 0.00 0

M 0 0.00 0 0.00 0 0.00 0 0.00 0

F 0 NA 0 NA 0 NA 0 NA 0

Total 0 0.00 0 0.00 0 0.00 0 0.00 0

M 0 NA 0 NA 0 NA 0 NA 0

F 0 0.00 0 0.00 0 0.00 0 0.00 0

Total 0 0.00 0 0.00 0 0.00 0 0.00 0

M 0 NA 0 NA 0 NA 0 NA 0

F 0 NA 0 NA 0 NA 0 NA 0

Total 0 NA 0 NA 0 NA 0 NA 0

M 6,418 0.05 11 0.00 9,307 0.08 0 0.00 241

F 15,385 0.11 1 0.00 13,674 0.09 0 0.00 555

Total 21,803 0.08 12 0.00 22,981 0.09 0 0.00 796

50-64

65-74

75-84

85+

Unknown

Total





Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips

Average Scrips PMPY

for Clindamycins

Total Misc. Antibiotics of

Concern Scrips

Average Scrips PMPY for Misc. Antibiotics of

Concern

0.00 1096 0.02 14 0.00

0.00 1093 0.02 12 0.00

0.00 2,189 0.02 26 0.00

0.00 807 0.02 0 0.00

0.00 973 0.02 3 0.00

0.00 1,780 0.02 3 0.00

0.00 192 0.04 3 0.00

0.00 1803 0.07 15 0.00

0.00 1,995 0.07 18 0.00

0.00 107 0.07 5 0.00

0.00 625 0.08 17 0.00

0.00 732 0.08 22 0.00



0.00 17 0.05 0 0.00

0.00 80 0.07 3 0.00

0.00 97 0.06 3 0.00

0.00 0 0.00 0 0.00

0.00 0 0.00 0 0.00

0.00 0 0.00 0 0.00

0.00 0 0.00 0 0.00

NA 0 NA 0 NA

0.00 0 0.00 0 0.00

NA 0 NA 0 NA

0.00 0 0.00 0 0.00

0.00 0 0.00 0 0.00

NA 0 NA 0 NA

NA 0 NA 0 NA

NA 0 NA 0 NA

0.00 2,219 0.02 22 0.00

0.00 4,574 0.03 50 0.00

0.00 6,793 0.03 72 0.00

Average Scrips

PMPY for Macrolides

(not azith. or clarith.)

Total Penicillin

Scrips

Average Scrips PMPY for Penicillins

Total Tetracycline

Scrips


Tetracyclines

Total Misc. Antibiotic

Scrips

Average Scrips

PMPY for Misc.

Antibiotics

0.00 43043 0.61 20 0.00 166 0.00

0.00 40962 0.59 17 0.00 398 0.01

0.00 84,005 0.60 37 0.00 564 0.00

0.00 8322 0.19 2263 0.05 199 0.00

0.00 10340 0.24 2637 0.06 1857 0.04

0.00 18,662 0.22 4,900 0.06 2,056 0.02

0.01 1085 0.21 472 0.09 100 0.02

0.01 9367 0.37 3253 0.13 12449 0.49

0.01 10,452 0.34 3,725 0.12 12,549 0.41

0.01 486 0.31 146 0.09 63 0.04

0.01 2807 0.37 1143 0.15 2451 0.32



0.01 3,293 0.36 1,289 0.14 2,514 0.27

0.00 90 0.29 41 0.13 14 0.05

0.01 344 0.28 144 0.12 192 0.16

0.01 434 0.28 185 0.12 206 0.13

0.00 0 0.00 0 0.00 0 0.00

0.00 3 0.71 0 0.00 0 0.00

0.00 3 0.54 0 0.00 0 0.00

0.00 0 0.00 1 4.00 0 0.00

NA 0 NA 0 NA 0 NA

0.00 0 0.00 1 4.00 0 0.00

NA 0 NA 0 NA 0 NA

0.00 0 0.00 0 0.00 0 0.00

0.00 0 0.00 0 0.00 0 0.00

NA 0 NA 0 NA 0 NA

NA 0 NA 0 NA 0 NA

NA 0 NA 0 NA 0 NA

0.00 53,026 0.44 2,943 0.02 542 0.00

0.00 63,823 0.44 7,194 0.05 17,347 0.12

0.00 116,849 0.44 10,137 0.04 17,889 0.07



Male Female Total

0-9 NR NR NR

10-17 NR NR NR

18-34 NR NR NR

35-49 NR NR NR

50-64 NR NR NR

65-74 NR NR NR

75-84 NR NR NR

85+ NR NR NR

Unknown NR NR NR

Total NR NR NR

Age SexTotal

Antibiotic Scrips


Antibiotics

Total Days Supplied for All Antibiotic Scrips

Average Days Supplied per

Antibiotic Scrip

Total Number of Scrips for Antibiotics of

Concern




Antibiotic Scrips

M NR NR NR NR NR NR NR

F NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR











0-9

10-17

18-34

35-49

Antibiotic Utilization: Dual Eligibles (ABXB)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Member Months

AgeMember Months





















Age SexTotal

Quinolone Scrips


Quinolones

Total Cephalosporin

2nd-4th Generation

Scrips


Cephalosporins 2nd-4th Generation

Total Azithromycin

and Clarithromycin

Scrips


Azithromycins and

Clarithromycins


Scrips















10-17

18-34

35-49

75-84

85+

Unknown

Total


0-9

50-64

65-74





















Age Sex


Scrips


Absorbable Sulfonamides

Total Aminoglycoside

Scrips


Aminoglycosides

Total 1st Generation

Cephalosporin Scrips

Average Scrips PMPY for 1st Generation

Cephalosporins

Total Lincosamide

Scrips


Lincosamides












18-34

35-49

85+

Unknown

Total


0-9

10-17

50-64

65-74

75-84






















Unknown

Total

50-64

65-74

75-84

85+





Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips

Average Scrips PMPY

for Clindamycins


Concern Scrips


Concern

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR



NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

Total Macrolides


Average Scrips

PMPY for Macrolides


Total Penicillin

Scrips


Total Tetracycline

Scrips


Tetracyclines


Scrips

Average Scrips

PMPY for Misc.

Antibiotics

NR NR NR NR NR NR NR NR


































Male Female Total

0-9 NR NR NR

10-17 NR NR NR

18-34 NR NR NR

35-49 NR NR NR

50-64 NR NR NR

65-74 NR NR NR

75-84 NR NR NR

85+ NR NR NR

Unknown NR NR NR

Total NR NR NR

Age SexTotal

Antibiotic Scrips


Antibiotics



Antibiotic Scrip

Total Number of Scrips for

Antibiotics of Concern




Antibiotic Scrips













0-9

10-17

18-34

35-49

Antibiotic Utilization: Disabled (ABXC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Member Months

AgeMember Months






















Age SexTotal

Quinolone Scrips


Quinolones

Total Cephalosporin

2nd-4th Generation

Scrips


Cephalosporins 2nd-4th

Generation

Total Azithromycin

and Clarithromycin

Scrips


Azithromycins and

Clarithromycins


Scrips













10-17

18-34

75-84

85+

Unknown

Total


0-9

50-64

65-74























Age Sex


Scrips




Scrips


Aminoglycosides




Cephalosporins

Total Lincosamide

Scrips


Lincosamides










18-34

85+

Unknown

Total


0-9

10-17

35-49

50-64

65-74

75-84
























Unknown

Total

35-49

50-64

65-74

75-84

85+





Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips


Clindamycins


Concern Scrips


Concern

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR



NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

Total Macrolides


Average Scrips

PMPY for Macrolides


Total Penicillin Scrips


Total Tetracycline

Scrips


Tetracyclines


Scrips

Average Scrips

PMPY for Misc.

Antibiotics



































Male Female Total

0-9 NR NR NR

10-17 NR NR NR

18-34 NR NR NR

35-49 NR NR NR

50-64 NR NR NR

65-74 NR NR NR

75-84 NR NR NR

85+ NR NR NR

Unknown NR NR NR

Total NR NR NR

Age SexTotal

Antibiotic Scrips


Antibiotics



Antibiotic Scrip

Total Number of Scrips for

Antibiotics of Concern




Antibiotic Scrips














0-9

10-17

18-34

35-49

Antibiotic Utilization: Other (ABXD)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Member Months

AgeMember Months





















Age SexTotal

Quinolone Scrips


Quinolones

Total Cephalosporin

2nd-4th Generation Scrips


Cephalosporins 2nd-4th

Generation

Total Azithromycin

and Clarithromycin

Scrips


Azithromycins and

Clarithromycins


Scrips














10-17

18-34

35-49

75-84

85+

Unknown

Total


0-9

50-64

65-74






















Age Sex


Scrips




Scrips


Aminoglycosides




Cephalosporins

Total Lincosamide

Scrips


Lincosamides











18-34

85+

Unknown

Total


0-9

10-17

50-64

65-74

75-84























Unknown

Total

35-49

50-64

65-74

75-84

85+





Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips


Clindamycins


Concern Scrips

Average Scrips PMPY

for Misc. Antibiotics of

Concern

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR



NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

NR NR NR NR NR NR

Total Macrolides


Average Scrips

PMPY for Macrolides


Total Penicillin

Scrips


Total Tetracycline

Scrips

Average Scrips PMPY

for Tetracyclines


Scrips

Average Scrips

PMPY for Misc.

Antibiotics



































Number Percent

Family Medicine 1137 828 72.82%

Internal Medicine 1887 1425 75.52%

OB/GYN physicians 804 648 80.60%

Pediatricians 1252 977 78.04%

Geriatricians 18 17 94.44%

Other physician specialists 5077 4213 82.98%

Board Certification (BCR)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Type of Physician

Number of Physicians

in Each Practice

Area

Board Certification



Product/Product LineTotal

Number of Members*

HMO (Total) 274,262

Medicaid 274177

Commercial 0

Medicare (cost or risk) 85

Other 0

PPO (Total) 0

Medicaid 0

Commercial 0


Other 0

POS (Total) 0

Medicaid 0

Commercial 0


Other 0

FFS (Total) 0

Medicaid 0

Commercial 0


Other 0

Total 274,262

Total Membership (TLM)


* Total number of members in each category as of December 31 of the measurement year.



AgeMale

Member Months

Female Member Months

Total Member Months

<1 121969 118623 240,592

1-4 338478 327876 666,354

5-9 393003 383271 776,274

10-14 349433 342367 691,800

15-17 165935 165974 331,909

18-19 41797 59785 101,582

0-19 Subtotal 1,410,615 1,397,896 2,808,511

0-19 Subtotal: % 97.14% 79.93% 87.74%

20-24 4633 85184 89,817

25-29 6313 85093 91,406

30-34 8150 74306 82,456

35-39 7596 48646 56,242

40-44 6410 27723 34,133

20-44 Subtotal 33,102 320,952 354,054

20-44 Subtotal: % 2.28% 18.35% 11.06%

45-49 4724 15123 19,847

50-54 2285 8044 10,329

55-59 1096 4123 5,219

60-64 349 2601 2,950

45-64 Subtotal 8,454 29,891 38,345

45-64 Subtotal: % 0.58% 1.71% 1.20%

65-69 2 51 53

70-74 14 0 14

75-79 0 0 0

80-84 3 0 3

85-89 0 2 2

>=90 0 0 0

>=65 Subtotal 19 53 72

>=65 Subtotal: % 0.00% 0.00% 0.00%

Age Unknown 0 0 0

Enrollment by Product Line: Total (ENPA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Total 1,452,190 1,748,792 3,200,982



AgeMale

Member Months


Total Member Months

<1 NR NR NR

1-4 NR NR NR

5-9 NR NR NR

10-14 NR NR NR

15-17 NR NR NR

18-19 NR NR NR

0-19 Subtotal NR NR NR

0-19 Subtotal: % NR NR NR

20-24 NR NR NR

25-29 NR NR NR

30-34 NR NR NR

35-39 NR NR NR

40-44 NR NR NR



45-49 NR NR NR

50-54 NR NR NR

55-59 NR NR NR

60-64 NR NR NR



65-69 NR NR NR

70-74 NR NR NR

75-79 NR NR NR

80-84 NR NR NR

85-89 NR NR NR

>=90 NR NR NR

>=65 Subtotal NR NR NR

>=65 Subtotal: % NR NR NR

Age Unknown NR NR NR

Enrollment by Product Line: Dual Eligibles (ENPB)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Total NR NR NR



AgeMale

Member Months


Total Member Months

<1 NR NR NR

1-4 NR NR NR

5-9 NR NR NR

10-14 NR NR NR

15-17 NR NR NR

18-19 NR NR NR



20-24 NR NR NR

25-29 NR NR NR

30-34 NR NR NR

35-39 NR NR NR

40-44 NR NR NR



45-49 NR NR NR

50-54 NR NR NR

55-59 NR NR NR

60-64 NR NR NR



65-69 NR NR NR

70-74 NR NR NR

75-79 NR NR NR

80-84 NR NR NR

85-89 NR NR NR

>=90 NR NR NR




Enrollment by Product Line: Disabled (ENPC)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Total NR NR NR



AgeMale

Member Months


Total Member Months

<1 NR NR NR

1-4 NR NR NR

5-9 NR NR NR

10-14 NR NR NR

15-17 NR NR NR

18-19 NR NR NR



20-24 NR NR NR

25-29 NR NR NR

30-34 NR NR NR

35-39 NR NR NR

40-44 NR NR NR



45-49 NR NR NR

50-54 NR NR NR

55-59 NR NR NR

60-64 NR NR NR



65-69 NR NR NR

70-74 NR NR NR

75-79 NR NR NR

80-84 NR NR NR

85-89 NR NR NR

>=90 NR NR NR




Enrollment by Product Line: Other (ENPD)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



Total NR NR NR



State Number

Alabama 0

Alaska 0

Arizona 0

Arkansas 0

California 0

Colorado 0

Connecticut 0

Delaware 0

District of Columbia 0

Florida 0

Georgia 274177

Hawaii 0

Idaho 0

Illinois 0

Indiana 0

Iowa 0

Kansas 0

Kentucky 0

Louisiana 0

Maine 0

Maryland 0

Massachusetts 0

Michigan 0

Minnesota 0

Mississippi 0

Missouri 0

Montana 0

Nebraska 0

Nevada 0

New Hampshire 0

New Jersey 0

Enrollment by State (EBS)




New Mexico 0

New York 0

North Carolina 0

North Dakota 0

Ohio 0

Oklahoma 0

Oregon 0

Pennsylvania 0

Rhode Island 0

South Carolina 0

South Dakota 0

Tennessee 0

Texas 0

Utah 0

Vermont 0

Virginia 0

Washington 0

West Virginia 0

Wisconsin 0

Wyoming 0

American Samoa 0

Federated States of Micronesia 0

Guam 0

Commonwealth of Northern Marianas 0

Puerto Rico 0

Virgin Islands 0

Other 0

TOTAL 274,177



Total Unduplicated Membership During the Measurement Year

392695

Direct Total 92.01%

Health Plan Direct*

0.0000

CMS/State Database*

0.9201

Other* 0.0000

Direct Total 3.15%

Health Plan Direct*

0.0000

CMS/State Database*

0.0315

Other* 0.0000

Number Percentage Number Percentage Number Percentage Number Percentage

White 0 0.00% 433 100.00% 173907 45.73% 0 NR

Black or African American 0 0.00% 0 0.00% 172532 45.37% 0 NR

American-Indian and Alaska Native 0 0.00% 0 0.00% 352 0.09% 0 NR

Asian 0 0.00% 0 0.00% 7354 1.93% 0 NR

Native Hawaiian and Other Pacific Islanders 0 0.00% 0 0.00% 398 0.10% 0 NR

Some Other Race 0 0.00% 0 0.00% 6330 1.66% 0 NR

Two or More Races 0 0.00% 0 0.00% 0 0.00% 0 NR

Unknown 11955 100.00% 0 0.00% 19434 5.11% 0 NR

Declined 0 0.00% 0 0.00% 0 0.00% 0 NR

Total 11,955 100.00% 433 100.00% 380,307 100.00% 0 NR

*Enter percentage as a value between 0 and 1.

RaceHispanic or Latino Not Hispanic or Latino Unknown Ethnicity Declined Ethnicity

RaceIndirect Total*

0.0000 Total* 0.0799

Ethnicity Indirect Total*

0.0000 Total* 0.9685

Race/Ethnicity Diversity of Membership (RDM)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Race/Ethnicity Diversity of Membership

Percentage of Members for Whom the Organization has Race/Ethnicity Information by Data Collection

Direct Data Collection MethodIndirect Data Collection

MethodUnknown



Number Percentage174,340 44.40%

172,532 43.94%

352 0.09%

7,354 1.87%

398 0.10%

6,330 1.61%

0 0.00%

31,389 7.99%

0 0.00%

392,695 100.00%

Total



CategoryHealth Plan

DirectCMS/State Databases

Other Third-Party

Source

Spoken Language Preferred for Health Care* 0.0000 1.0000 0.0000

Preferred Language for Written Materials* 0.0000 1.0000 0.0000

Other Language Needs* 0.0000 0.0000 1.0000

Number Percentage

English 212660 54.15%

Non-English 28773 7.33%

Unknown 151262 38.52%

Declined 0 0.00%

Total* 392,695 100.00%

Number Percentage

English 212660 54.15%

Non-English 28773 7.33%

Unknown 151262 38.52%

Declined 0 0.00%

Total* 392,695 100.00%

Number Percentage

English 0 0.00%

Non-English 0 0.00%

Unknown 392695 100.00%

Declined 0 0.00%

Total* 392,695 100.00%

Other Language Needs

*Should sum to 100%

Language Diversity of Membership (LDM)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Percentage of Members With Known Language Value from Each Data Source

*Enter percentage as a value between 0 and 1.

Spoken Language Preferred for Health Care

Language Preferred for Written Materials



Measurement Year 2012

Weeks of Pregnancy Number Percentage

< 0 weeks 1300 9.04%

1-12 weeks 1091 7.59%

13-27 weeks 8400 58.43%

28 or more weeks 2463 17.13%

Unknown 1121 7.80%

Total 14,375 100.00%

Weeks of Pregnancy at Time of Enrollment in MCO (WOP)


Measurement Year





Rotated Measure


Adult BMI Assessment (aba) Y N 62.70% R Reportable

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (wcc)

Y N

BMI Percentile 40.74% R Reportable

Counseling for Nutrition 52.31% R Reportable

Counseling for Physical Activity 39.81% R Reportable

Childhood Immunization Status (cis) Y N

DTaP 88.66% R Reportable

IPV 96.30% R Reportable

MMR 94.21% R Reportable

HiB 95.83% R Reportable

Hepatitis B 93.98% R Reportable

VZV 95.60% R Reportable

Pneumococcal Conjugate 88.43% R Reportable

Hepatitis A 93.98% R Reportable

Rotavirus 71.53% R Reportable

Influenza 45.37% R Reportable










Immunizations for Adolescents (ima) Y




Effectiveness of Care: Prevention and Screening





Rotated Measure





Meningococcal 73.51% R Reportable

Tdap/Td 84.68% R Reportable


Human Papillomavirus Vaccine for Female Adolescents (hpv)


Lead Screening in Children (lsc) Y N 74.06% R Reportable

Breast Cancer Screening (bcs) Y 59.22% R Reportable

Cervical Cancer Screening (ccs) Y 72.09% R Reportable

Chlamydia Screening in Women (chl) Y




Appropriate Testing for Children with Pharyngitis (cwp)


Appropriate Treatment for Children With URI (uri) Y Y 82.66% R Reportable

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab)


Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)


Pharmacotherapy Management of COPD Exacerbation (pce)

Y Y

Systemic Corticosteroid 63.27% R Reportable

Bronchodilator 83.67% R ReportableUse of Appropriate Medications for People With Asthma (asm)

Y Y




Effectiveness of Care: Respiratory Conditions





Rotated Measure







Medication Management for People With Asthma (mma)

Y Y











Asthma Medication Ratio (amr) Y Y







Y Y



Controlling High Blood Pressure (cbp) Y 38.72% R ReportablePersistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Y Y NA R Denominator fewer than 30

Comprehensive Diabetes Care (cdc) Y N

Effectiveness of Care: Cardiovascular

Effectiveness of Care: Diabetes





Rotated Measure





Hemoglobin A1c (HbA1c) Testing 79.37% R Reportable

HbA1c Poor Control (>9.0%) 53.58% R Reportable



Eye Exam (Retinal) Performed 48.25% R Reportable



Medical Attention for Nephropathy 74.38% R Reportable





Use of Imaging Studies for Low Back Pain (lbp) Y 74.22% R Reportable

Antidepressant Medication Management (amm) Y Y

Effective Acute Phase Treatment 54.16% R Reportable

Effective Continuation Phase Treatment 36.81% R ReportableFollow-Up Care for Children Prescribed ADHD Medication (add)

Y Y

Initiation Phase 42.32% R Reportable

Continuation and Maintenance (C&M) Phase 58.15% R Reportable

Follow-Up After Hospitalization for Mental Illness (fuh)

Y Y



Effectiveness of Care: Musculoskeletal






Rotated Measure





Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd)


Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)


Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc)


Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)


Annual Monitoring for Patients on Persistent Medications (mpm)

Y Y

ACE Inhibitors or ARBs 90.93% R Reportable

Digoxin NA R Denominator fewer than 30

Diuretics 89.80% R Reportable

Anticonvulsants 61.43% R Reportable



Y



65+ Years NA R Denominator fewer than 30

Total 84.79% R ReportableChildren and Adolescents' Access to Primary Care Practitioners (cap)

Y

12-24 Months 97.55% R Reportable

25 Months - 6 Years 91.44% R Reportable


Effectiveness of Care: Medication Management

Access/Availability of Care





Rotated Measure






Annual Dental Visit (adv) Y Y









Y Y

Initiation of AOD Treatment: 13-17 Years 39.37% R Reportable

Engagement of AOD Treatment: 13-17 Years 15.24% R Reportable

Initiation of AOD Treatment: 18+ Years 42.60% R Reportable

Engagement of AOD Treatment: 18+ Years 8.50% R Reportable

Initiation of AOD Treatment: Total 41.87% R Reportable

Engagement of AOD Treatment: Total 10.01% R Reportable

Prenatal and Postpartum Care (ppc) Y

Timeliness of Prenatal Care 84.72% R Reportable

Postpartum Care 59.49% R Reportable

Call Answer Timeliness (cat) Y 85.71% R Reportable

Frequency of Ongoing Prenatal Care (fpc) Y

<21 Percent 10.65% R Reportable




81+ Percent 66.44% R Reportable

Well-Child Visits in the First 15 Months of Life (w15)

Y N

Utilization





Rotated Measure






1 Visit 1.74% R Reportable





6+ Visits 63.03% R ReportableWell-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)

Y N 68.21% R Reportable

Adolescent Well-Care Visits (awc) Y N 46.58% R Reportable

Frequency of Selected Procedures (fsp) Y R Reportable

Ambulatory Care: Total (amba) Y R Reportable

Ambulatory Care: Dual Eligibles (ambb) N NR Measure Unselected

Ambulatory Care: Disabled (ambc) N NR Measure Unselected

Ambulatory Care: Other (ambd) N NR Measure Unselected

Inpatient Utilization--General Hospital/Acute Care: Total (ipua)

Y R Reportable

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)


Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)


Inpatient Utilization--General Hospital/Acute Care: Other (ipud)


Identification of Alcohol and Other Drug Services: Total (iada)

Y Y R Reportable

Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)


Identification of Alcohol and Other Drug Services: Disabled (iadc)






Rotated Measure







Mental Health Utilization: Total (mpta) Y Y R Reportable

Mental Health Utilization: Dual Eligibles (mptb) N N NR Measure Unselected

Mental Health Utilization: Disabled (mptc) N N NR Measure Unselected

Mental Health Utilization: Other (mptd) N N NR Measure Unselected

Antibiotic Utilization: Total (abxa) Y Y R Reportable

Antibiotic Utilization: Dual Eligibles (abxb) N N NR Measure Unselected

Antibiotic Utilization: Disabled (abxc) N N NR Measure Unselected

Antibiotic Utilization: Other (abxd) N N NR Measure Unselected

Relative Resource Use for People With Diabetes (rdi)

Y R Reportable

Relative Resource Use for People With Asthma (ras)

Y Y R Reportable


Y R Reportable

Relative Resource Use for People With Hypertension (rhy)

Y R Reportable

Relative Resource Use for People With COPD (rco) Y R Reportable

Board Certification (bcr) Y R Reportable

Total Membership (tlm) Y R Reportable

Enrollment by Product Line: Total (enpa) Y R Reportable

Enrollment by Product Line: Dual Eligibles (enpb) N NR Measure Unselected

Enrollment by Product Line: Disabled (enpc) N NR Measure Unselected

Enrollment by Product Line: Other (enpd) N NR Measure Unselected

Relative Resource Use

Health Plan Descriptive Information





Rotated Measure





Enrollment by State (ebs) Y R Reportable

Race/Ethnicity Diversity of Membership (rdm) Y R Reportable

Language Diversity of Membership (ldm) Y R Reportable

Weeks of Pregnancy at Time of Enrollment in MCO (wop)

Y R Reportable



Data ElementMeasure

DataEligible Population 1051

Exclusions 63

Eligible Population per 1,000 Member Year Medical 1,011.87

Eligible Population per 1,000 Member Year Pharmacy 1,011.87

NameBrandOnlyCount(N1) 5995

NameBrandGenericExistsCount(N2) 2259

GenericOnlyCount (G1) 5678

GenericNameBrandExistsCount (G2) 42371

Total Prescriptions (N1+N2+G1+G2) 56,303.00

Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] 95.51%

Generic Substitution Rate [(G2)/(N2+G2)] 94.94%

Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)] 85.34%

Inpatient Facility PMPM 278.11

E&M Inpatient Services PMPM 14.22

E&M Outpatient Services PMPM 89.12

Surgery & Procedure Inpatient Services PMPM 15.26

Surgery & Procedure Outpatient Services PMPM 83.61

Imaging Services PMPM 72.21

Laboratory Services PMPM 35.94

Pharmacy PMPM 162.66

Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY 1,215.98

Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY 256.10

Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY 205.07

Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY 36.59

Inpatient Facility: Nonacute Days per 1000 MY 30.81

Inpatient Facility: Nonacute Discharges per 1000 MY 1.93

Inpatient Facility Acute Medical ALOS 4.75

Inpatient Facility Acute Surgery ALOS 5.61

Inpatient Facility Nonacute ALOS 16.00

Total Inpatient Facility Acute ALOS 4.86

Total Inpatient Facility ALOS 4.93

Relative Resource Use for People With Diabetes (RDI)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, SpecProj: None)



ED Discharges per 1000 MY Medical 2,443.52

Cardiac Catheterization per 1000 MY Medical 30.81

PCI per 1000 MY Medical 3.85

CABG per 1000 MY Medical 0.00

Carotid Endarterectomy per 1000 MY Medical 0.00

Carotid Artery Stenosis Diagnostic Test per 1000 MY Medical 0.00

Cardiac Computed Tomography per 1000 MY Medical 0.00

CAD Diagnostic Test Using EBCT/Nuclear Imaging Stress Tests per 1000 MY Medical 105.91

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab)Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)





Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)






Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd)Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc)Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)Effectiveness of Care: Medication ManagementAnnual Monitoring for Patients on Persistent Medications (mpm)


Children and Adolescents' Access to Primary Care Practitioners (cap)




Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)

Inpatient Utilization--General Hospital/Acute Care: Total (ipua)Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)Inpatient Utilization--General Hospital/Acute Care: Other (ipud)Identification of Alcohol and Other Drug Services: Total (iada)Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)Identification of Alcohol and Other Drug Services: Disabled (iadc)Identification of Alcohol and Other Drug Services: Other (iadd)






Data ElementMeasure

Data

Eligible Population 3602

Exclusions 521


















Pharmacy PMPM 97.36

Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY 113.40








Inpatient Facility Nonacute ALOS 28.00



Relative Resource Use for People With Asthma (RAS)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)



ED Discharges per 1000 MY Medical 947.58



















Inpatient Utilization--General Hospital/Acute Care: Total (ipua)Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)Inpatient Utilization--General Hospital/Acute Care: Other (ipud)Identification of Alcohol and Other Drug Services: Total (iada)Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)Identification of Alcohol and Other Drug Services: Disabled (iadc)Identification of Alcohol and Other Drug Services: Other (iadd)






Data ElementMeasure

Data


Exclusions 3



























Inpatient Facility Nonacute ALOS NA



Relative Resource Use for People With Cardiovascular Conditions (RCA)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)




Cardiac Catheterization per 1000 MY Medical 209.19

PCI per 1000 MY Medical 209.19

CABG per 1000 MY Medical 0.00

Carotid Endarterectomy per 1000 MY Medical 0.00

Carotid Artery Stenosis Diagnostic Test per 1000 MY Medical 0.00

Cardiac Computed Tomography per 1000 MY Medical 0.00

CAD Diagnostic Test Using EBCT/Nuclear Imaging Stress Tests per 1000 MY Medical 475.44



















Inpatient Utilization--General Hospital/Acute Care: Total (ipua)Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)Inpatient Utilization--General Hospital/Acute Care: Other (ipud)Identification of Alcohol and Other Drug Services: Total (iada)Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)Identification of Alcohol and Other Drug Services: Disabled (iadc)







Data ElementMeasure

Data


Exclusions 240



















Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY 791.40










Relative Resource Use for People With Hypertension (RHY)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)






























Data ElementMeasure

Data


Exclusions 17





























Relative Resource Use for People With COPD (RCO)AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)





























Documents

AMERIGROUP Community Care Validation of Performance Measures